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Sample records for adopting electronic health

  1. Macro influencers of electronic health records adoption.

    PubMed

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

    2015-01-01

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

  2. Adoption Factors of the Electronic Health Record: A Systematic Review

    PubMed Central

    2016-01-01

    Background The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures. Objective The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States. Methods Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012–09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity. Results Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues. Conclusions The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite

  3. Barriers for Adopting Electronic Health Records (EHRs) by Physicians

    PubMed Central

    Ajami, Sima

    2013-01-01

    CONFLICT OF INTEREST: NONE DECLARED Introduction Electronic Medical Records (EMRs) are computerized medical information systems that collect, store and display patient information. They are means to create legible and organized recordings and to access clinical information about individual patients. Despite of the positive effects of the EMRs usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. The EHRs represent an essential tool for improving both in the safety and quality of health care, though physicians must actively use these systems to accrue the benefits. This study was unsystematic-review. Aim The aim of this study was to express barriers perceived y physicians to the adoption of the EHRs. Method of the study This study was non-systematic reviewed which the literature was searched on barriers perceived by physicians to the adoption of Electronic Health Records (EHRs) with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. Discussion For our searches, we employed the following keywords and their combinations: physicians, electronic medical record, electronic health record, barrier, and adoption in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 27 of them were selected based on their relevancy. Electronic health record use requires the presence of certain user and system attributes, support from others, and numerous organizational and environment facilitators. PMID:24058254

  4. Minnesota clinics' adoption, use and exchange of electronic health information.

    PubMed

    Soderberg, Karen; Laventure, Marty

    2013-09-01

    In 2007, Minnesota passed a law requiring all health care providers in the state to implement an interoperable electronic health record (EHR) system by January 1, 2015. Since then, the Minnesota Department of Health has been monitoring progress each year by surveying hospitals, clinics and other health and health care facilities about their EHR use. This article summarizes findings from the 2013 survey of ambulatory clinics. Those results show Minnesota clinics are well on the way to achieving the state's goals for using EHRs to exchange information: 87% of clinics have adopted EHRs, 80% routinely use medication guides and alerts, and 36% exchange health information with unaffiliated settings.

  5. Hospital financial position and the adoption of electronic health records.

    PubMed

    Ginn, Gregory O; Shen, Jay J; Moseley, Charles B

    2011-01-01

    The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2442 acute care hospitals. The study was cross-sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) fulltime equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation-based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment. PMID:21991681

  6. Hospital financial position and the adoption of electronic health records.

    PubMed

    Ginn, Gregory O; Shen, Jay J; Moseley, Charles B

    2011-01-01

    The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2442 acute care hospitals. The study was cross-sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) fulltime equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation-based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment.

  7. Enabling Quality: Electronic Health Record Adoption and Meaningful Use Readiness in Federally Funded Health Centers.

    PubMed

    Wittie, Michael; Ngo-Metzger, Quyen; Lebrun-Harris, Lydie; Shi, Leiyu; Nair, Suma

    2016-01-01

    The Health Resources and Services Administration has supported the adoption of electronic health records (EHRs) by federally funded health centers for over a decade; however, little is known about health centers' current EHR adoption rates, progress toward Meaningful Use, and factors related to adoption. We analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80% of health centers reported using an EHR, and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding; however, there were small variations in adoption by total patient cost and percent of revenue from grants. Findings revealed no evidence of a digital divide among health centers, indicating that health centers are implementing EHRs, in keeping with their mission to reduce health disparities.

  8. 77 FR 48007 - Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-10

    ... the Health Care EFT Standards IFC (77 FR 1556). The standard for the ERA is the X12 835 TR3, adopted... Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and... CFR Part 162 RIN 0938-AR01 Administrative Simplification: Adoption of Operating Rules for Health...

  9. Improving Service Coordination and Reducing Mental Health Disparities Through Adoption of Electronic Health Records

    PubMed Central

    McGregor, Brian; Mack, Dominic; Wrenn, Glenda; Shim, Ruth S.; Holden, Kisha; Satcher, David

    2015-01-01

    Despite widespread support for removing barriers to the use of electronic health records (EHRs) in behavioral health care, adoption of EHRs in behavioral health settings lags behind adoption in other areas of health care. The authors discuss barriers to use of EHRs among behavioral health care practitioners, suggest solutions to overcome these barriers, and describe the potential benefits of EHRs to reduce behavioral health care disparities. Thoughtful and comprehensive strategies will be needed to design EHR systems that address concerns about policy, practice, costs, and stigma and that protect patients’ privacy and confidentiality. However, these goals must not detract from continuing to challenge the notion that behavioral health and general medical health should be treated as separate and distinct. Ultimately, utilization of EHRs among behavioral health care providers will improve the coordination of services and overall patient care, which is essential to reducing mental health disparities. PMID:25975885

  10. Improving Service Coordination and Reducing Mental Health Disparities Through Adoption of Electronic Health Records.

    PubMed

    McGregor, Brian; Mack, Dominic; Wrenn, Glenda; Shim, Ruth S; Holden, Kisha; Satcher, David

    2015-09-01

    Despite widespread support for removing barriers to the use of electronic health records (EHRs) in behavioral health care, adoption of EHRs in behavioral health settings lags behind adoption in other areas of health care. The authors discuss barriers to use of EHRs among behavioral health care practitioners, suggest solutions to overcome these barriers, and describe the potential benefits of EHRs to reduce behavioral health care disparities. Thoughtful and comprehensive strategies will be needed to design EHR systems that address concerns about policy, practice, costs, and stigma and that protect patients' privacy and confidentiality. However, these goals must not detract from continuing to challenge the notion that behavioral health and general medical health should be treated as separate and distinct. Ultimately, utilization of EHRs among behavioral health care providers will improve the coordination of services and overall patient care, which is essential to reducing mental health disparities.

  11. Determinants of primary care nurses' intention to adopt an electronic health record in their clinical practice.

    PubMed

    Leblanc, Genevieve; Gagnon, Marie-Pierre; Sanderson, Duncan

    2012-09-01

    A provincial electronic health record is being developed in the Province of Quebec (and in all other provinces in Canada), and authorities hope that it will enable a safer and more efficient healthcare system for citizens. However, the expected benefits can occur only if healthcare professionals, including nurses, adopt this technology. Although attention to the use of the electronic health record by nurses is growing, better understanding of nurses' intention to use an electronic health record is needed and could help managers to better plan its implementation. This study examined the factors that influence primary care nurses' intention to adopt the provincial electronic health record, since intention influences electronic health record use and implementation success. Using a modified version of Ajzen's Theory of Planned Theory of Planned Behavior, a questionnaire was developed and pretested. Questionnaires were distributed to 199 primary care nurses. Multiple hierarchical regression indicated that the Theory of Planned Behavior variables explained 58% of the variance in nurses' intention to adopt an electronic health record. The strong intention to adopt the electronic health record is mainly determined by perceived behavioral control, normative beliefs, and attitudes. The implications of the study are that healthcare managers could facilitate adoption of an electronic health record by strengthening nurses' intention to adopt the electronic health record, which in turn can be influenced through interventions oriented toward the belief that using an electronic health record will improve the quality of patient care. PMID:22592453

  12. Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?

    PubMed Central

    Ford, Eric W.; Menachemi, Nir; Phillips, M. Thad

    2006-01-01

    Objectives: The purpose of this study was threefold. First, we gathered and synthesized the historic literature regarding electronic health record (EHR) adoption rates among physicians in small practices (ten or fewer members). Next, we constructed models to project estimated future EHR adoption trends and timelines. We then determined the likelihood of achieving universal EHR adoption in the near future and articulate how barriers can be overcome in the small and solo practice medical environment. Design: This study used EHR adoption data from six previous surveys of small practices to estimate historic market penetration rates. Applying technology diffusion theory, three future adoption scenarios, optimistic, best estimate, and conservative, are empirically derived. Measurement: EHR adoption parameters, external and internal coefficients of influence, are estimated using Bass diffusion models. Results: All three EHR scenarios display the characteristic diffusion S curve that is indicative that the technology is likely to achieve significant market penetration, given enough time. Under current conditions, EHR adoption will reach its maximum market share in 2024 in the small practice setting. Conclusion: The promise of improved care quality and cost control has prompted a call for universal EHR adoption by 2014. The EHR products now available are unlikely to achieve full diffusion in a critical market segment within the time frame being targeted by policy makers. PMID:16221936

  13. Multi-level analysis of electronic health record adoption by health care professionals: A study protocol

    PubMed Central

    2010-01-01

    Background The electronic health record (EHR) is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors. Methods A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada). At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary. Results The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings. Conclusions These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition, this research constitutes a

  14. Electronic Health Record Patient Portal Adoption by Health Care Consumers: An Acceptance Model and Survey

    PubMed Central

    2016-01-01

    Background The future of health care delivery is becoming more citizen centered, as today’s user is more active, better informed, and more demanding. Worldwide governments are promoting online health services, such as electronic health record (EHR) patient portals and, as a result, the deployment and use of these services. Overall, this makes the adoption of patient-accessible EHR portals an important field to study and understand. Objective The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods We applied a new adoption model using, as a starting point, Ventkatesh's Unified Theory of Acceptance and Use of Technology in a consumer context (UTAUT2) by integrating a new construct specific to health care, a new moderator, and new relationships. To test the research model, we used the partial least squares (PLS) causal modelling approach. An online questionnaire was administrated. We collected 360 valid responses. Results The statistically significant drivers of behavioral intention are performance expectancy (beta=.200; t=3.619), effort expectancy (beta=.185; t=2.907), habit (beta=.388; t=7.320), and self-perception (beta=.098; t=2.285). The predictors of use behavior are habit (beta=0.206; t=2.752) and behavioral intention (beta=0.258; t=4.036). The model explained 49.7% of the variance in behavioral intention and 26.8% of the variance in use behavior. Conclusions Our research helps to understand the desired technology characteristics of EHR portals. By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt EHR portals or not. The inclusion of specific constructs and relationships related to the health care consumer area also had a significant impact on understanding the adoption of EHR portals. PMID:26935646

  15. Hospital Electronic Health Record Adoption and Its Influence on Postoperative Sepsis

    ERIC Educational Resources Information Center

    Fareed, Naleef

    2013-01-01

    Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient…

  16. Electronic Health Record Adoption as a Function of Success: Implications for Meaningful Use

    ERIC Educational Resources Information Center

    Naser, Riyad J.

    2012-01-01

    Successful electronic health records (EHR) implementation has the potential to transform the entire care delivery process across the enterprise. However, the rate of EHR implementation and use among physicians has been slow. Different factors have been reported in the literature that may hinder adoption of EHR. Identifying and managing these…

  17. Electronic Health Record Adoption In US Hospitals: Progress Continues, But Challenges Persist.

    PubMed

    Adler-Milstein, Julia; DesRoches, Catherine M; Kralovec, Peter; Foster, Gregory; Worzala, Chantal; Charles, Dustin; Searcy, Talisha; Jha, Ashish K

    2015-12-01

    Achieving nationwide adoption of electronic health records (EHRs) remains an important policy priority. While EHR adoption has increased steadily since 2010, it is unclear how providers that have not yet adopted will fare now that federal incentives have converted to penalties. We used 2008-14 national data, which includes the most recently available, to examine hospital EHR trends. We found large gains in adoption, with 75 percent of US hospitals now having adopted at least a basic EHR system--up from 59 percent in 2013. However, small and rural hospitals continue to lag behind. Among hospitals without a basic EHR system, the function most often not yet adopted (in 61 percent of hospitals) was physician notes. We also saw large increases in the ability to meet core stage 2 meaningful-use criteria (40.5 percent of hospitals, up from 5.8 percent in 2013); much of this progress resulted from increased ability to meet criteria related to exchange of health information with patients and with other physicians during care transitions. Finally, hospitals most often reported up-front and ongoing costs, physician cooperation, and complexity of meeting meaningful-use criteria as challenges. Our findings suggest that nationwide hospital EHR adoption is in reach but will require attention to small and rural hospitals and strategies to address financial challenges, particularly now that penalties for lack of adoption have begun. PMID:26561387

  18. A Comparison of Physician Pre-Adoption and Adoption Views on Electronic Health Records in Canadian Medical Practices

    PubMed Central

    Cocosila, Mihail

    2011-01-01

    Background There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations. Objective We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians’ point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model. Methods We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques. Results We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect –.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049

  19. Adoption factors associated with electronic health record among long-term care facilities: a systematic review

    PubMed Central

    Kruse, Clemens Scott; Mileski, Michael; Alaytsev, Vyachelslav; Carol, Elizabeth; Williams, Ariana

    2015-01-01

    Objectives The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. Setting We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. Participants Search results were filtered by date range, full text, English language and academic journals (n=22). Interventions Multiple members of the research team read each article to confirm applicability and study conclusions. Primary and secondary outcome measures Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. Results Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. Conclusions Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs. PMID:25631311

  20. Adoption of Electronic Personal Health Records in Canada: Perceptions of Stakeholders

    PubMed Central

    Gagnon, Marie-Pierre; Payne-Gagnon, Julie; Breton, Erik; Fortin, Jean-Paul; Khoury, Lara; Dolovich, Lisa; Price, David; Wiljer, David; Bartlett, Gillian; Archer, Norman

    2016-01-01

    Background: Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption. Methods: Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted. Results: We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security). Conclusion: ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem well-prepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders

  1. Adoption of Electronic Personal Health Records in Canada: Perceptions of Stakeholders

    PubMed Central

    Gagnon, Marie-Pierre; Payne-Gagnon, Julie; Breton, Erik; Fortin, Jean-Paul; Khoury, Lara; Dolovich, Lisa; Price, David; Wiljer, David; Bartlett, Gillian; Archer, Norman

    2016-01-01

    Background: Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption. Methods: Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted. Results: We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security). Conclusion: ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem well-prepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders

  2. Adoption and Utilization of Electronic Health Record Systems by Long-Term Care Facilities in Texas

    PubMed Central

    Wang, Tiankai; Biedermann, Sue

    2012-01-01

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

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

    PubMed Central

    2010-01-01

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

  4. Adoption and Barriers to Adoption of Electronic Health Records by Nurses in Three Governmental Hospitals in Eastern Province, Saudi Arabia.

    PubMed

    El Mahalli, Azza

    2015-01-01

    Although electronic health records (EHRs) have been implemented in many hospitals and healthcare providers benefit from their effective and efficient data processing, their evaluation from nurses has received little attention. This project aimed to assess the adoption and barriers to the use of an EHR system by nurses at three governmental hospitals implementing the same EHR software and functionalities in Eastern Province, Saudi Arabia. The study was a cross-sectional, paper-based questionnaire study. SPSS version 20 was used for data entry and analysis, and descriptive statistics were calculated. The study found underutilization of almost all functionalities among all hospitals and no utilization of any communication tools with patients. In addition, there were no instances of "allowing patients to use the Internet to access parts of their health records." The most frequently cited barrier among all hospitals was "loss of access to medical records transiently if computer crashes or power fails" (88.6 percent). This was followed by "lack of continuous training/ support from information technology staff in hospital" (85.9 percent), "additional time required for data entry" (84.9 percent), and "system hanging up problem" (83.8 percent). Complexity of technology (81.6 percent) and lack of system customizability (81.1 percent) were also frequently reported problems. The formation of an EHR committee to discuss problems with the system in Saudi hospitals is recommended.

  5. Adoption and Barriers to Adoption of Electronic Health Records by Nurses in Three Governmental Hospitals in Eastern Province, Saudi Arabia.

    PubMed

    El Mahalli, Azza

    2015-01-01

    Although electronic health records (EHRs) have been implemented in many hospitals and healthcare providers benefit from their effective and efficient data processing, their evaluation from nurses has received little attention. This project aimed to assess the adoption and barriers to the use of an EHR system by nurses at three governmental hospitals implementing the same EHR software and functionalities in Eastern Province, Saudi Arabia. The study was a cross-sectional, paper-based questionnaire study. SPSS version 20 was used for data entry and analysis, and descriptive statistics were calculated. The study found underutilization of almost all functionalities among all hospitals and no utilization of any communication tools with patients. In addition, there were no instances of "allowing patients to use the Internet to access parts of their health records." The most frequently cited barrier among all hospitals was "loss of access to medical records transiently if computer crashes or power fails" (88.6 percent). This was followed by "lack of continuous training/ support from information technology staff in hospital" (85.9 percent), "additional time required for data entry" (84.9 percent), and "system hanging up problem" (83.8 percent). Complexity of technology (81.6 percent) and lack of system customizability (81.1 percent) were also frequently reported problems. The formation of an EHR committee to discuss problems with the system in Saudi hospitals is recommended. PMID:26604875

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

    PubMed

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

    2011-01-01

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

  7. Adoption and use of electronic health records among federally qualified health centers grew substantially during 2010-12.

    PubMed

    Jones, Emily B; Furukawa, Michael F

    2014-07-01

    Federally qualified health centers play an important role in providing health care to underserved populations. Recent substantial federal investments in health information technology have enabled health centers to expand their use of electronic health record (EHR) systems, but factors associated with adoption are not clear. We examined 2010-12 administrative data from the Health Resources and Services Administration's Uniform Data System for more than 1,100 health centers. We found that in 2012 nine out of ten health centers had adopted a EHR system, and half had adopted EHRs with basic capabilities. Seven in ten health centers reported that their providers were receiving meaningful-use incentive payments from the Centers for Medicare and Medicaid Services (CMS). Only one-third of health centers had EHR systems that could meet CMS's stage 1 meaningful-use core requirements. Health centers that met the stage 1 requirements had more than twice the odds of receiving quality recognition, compared with centers with less than basic EHRs. Policy initiatives should focus assistance on EHR capabilities with slower uptake; connect providers with technical assistance to support implementation; and leverage the connection between meaningful use and quality recognition programs.

  8. Adoption and use of electronic health records among federally qualified health centers grew substantially during 2010-12.

    PubMed

    Jones, Emily B; Furukawa, Michael F

    2014-07-01

    Federally qualified health centers play an important role in providing health care to underserved populations. Recent substantial federal investments in health information technology have enabled health centers to expand their use of electronic health record (EHR) systems, but factors associated with adoption are not clear. We examined 2010-12 administrative data from the Health Resources and Services Administration's Uniform Data System for more than 1,100 health centers. We found that in 2012 nine out of ten health centers had adopted a EHR system, and half had adopted EHRs with basic capabilities. Seven in ten health centers reported that their providers were receiving meaningful-use incentive payments from the Centers for Medicare and Medicaid Services (CMS). Only one-third of health centers had EHR systems that could meet CMS's stage 1 meaningful-use core requirements. Health centers that met the stage 1 requirements had more than twice the odds of receiving quality recognition, compared with centers with less than basic EHRs. Policy initiatives should focus assistance on EHR capabilities with slower uptake; connect providers with technical assistance to support implementation; and leverage the connection between meaningful use and quality recognition programs. PMID:25006154

  9. An Analysis of the External Environmental and Internal Organizational Factors Associated with Adoption of the Electronic Health Record

    ERIC Educational Resources Information Center

    Kruse, Clemens Scott

    2013-01-01

    Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple…

  10. Legal, ethical, and financial dilemmas in electronic health record adoption and use.

    PubMed

    Sittig, Dean F; Singh, Hardeep

    2011-04-01

    Electronic health records (EHRs) facilitate several innovations capable of reforming health care. Despite their promise, many currently unanswered legal, ethical, and financial questions threaten the widespread adoption and use of EHRs. Key legal dilemmas that must be addressed in the near-term pertain to the extent of clinicians' responsibilities for reviewing the entire computer-accessible clinical synopsis from multiple clinicians and institutions, the liabilities posed by overriding clinical decision support warnings and alerts, and mechanisms for clinicians to publically report potential EHR safety issues. Ethical dilemmas that need additional discussion relate to opt-out provisions that exclude patients from electronic record storage, sale of deidentified patient data by EHR vendors, adolescent control of access to their data, and use of electronic data repositories to redesign the nation's health care delivery and payment mechanisms on the basis of statistical analyses. Finally, one overwhelming financial question is who should pay for EHR implementation because most users and current owners of these systems will not receive the majority of benefits. The authors recommend that key stakeholders begin discussing these issues in a national forum. These actions can help identify and prioritize solutions to the key legal, ethical, and financial dilemmas discussed, so that widespread, safe, effective, interoperable EHRs can help transform health care. PMID:21422090

  11. Social networks and physician adoption of electronic health records: insights from an empirical study

    PubMed Central

    Padman, Rema; Krackhardt, David; Johnson, Michael P; Diamond, Herbert S

    2010-01-01

    Objective To study how social interactions influence physician adoption of an electronic health records (EHR) system. Design A social network survey was used to delineate the structure of social interactions among 40 residents and 15 attending physicians in an ambulatory primary care practice. Social network analysis was then applied to relate the interaction structures to individual physicians' utilization rates of an EHR system. Measurements The social network survey assessed three distinct types of interaction structures: professional network based on consultation on patient care-related matters; friendship network based on personal intimacy; and perceived influence network based on a person's perception of how other people have affected her intention to adopt the EHR system. EHR utilization rates were measured as the proportion of patient visits in which sentinel use events consisting of patient data documentation or retrieval activities were recorded. The usage data were collected over a time period of 14 months from computer-recorded audit trail logs. Results Neither the professional nor the perceived influence network is correlated with EHR usage. The structure of the friendship network significantly influenced individual physicians' adoption of the EHR system. Residents who occupied similar social positions in the friendship network shared similar EHR utilization rates (p<0.05). In other words, residents who had personal friends in common tended to develop comparable levels of EHR adoption. This effect is particularly prominent when the mutual personal friends of these ‘socially similar’ residents were attending physicians (p<0.001). Conclusions Social influence affecting physician adoption of EHR seems to be predominantly conveyed through interactions with personal friends rather than interactions in professional settings. PMID:20442152

  12. Electronic Health Records: Applying Diffusion of Innovation Theory to the Relationship between Multifactor Authentication and EHR Adoption

    ERIC Educational Resources Information Center

    Lockett, Daeron C.

    2014-01-01

    Electronic Health Record (EHR) systems are increasingly becoming accepted as future direction of medical record management systems. Programs such as the American Recovery and Reinvestment Act have provided incentives to hospitals that adopt EHR systems. In spite of these incentives, the perception of EHR adoption is that is has not achieved the…

  13. Office-based physicians are responding to incentives and assistance by adopting and using electronic health records.

    PubMed

    Hsiao, Chun-Ju; Jha, Ashish K; King, Jennifer; Patel, Vaishali; Furukawa, Michael F; Mostashari, Farzad

    2013-08-01

    Expanding the use of interoperable electronic health record (EHR) systems to improve health care delivery is a national policy priority. We used the 2010-12 National Ambulatory Medical Care Survey--Electronic Health Records Survey to examine which physicians in what types of practices are implementing the systems, and how they are using them. We found that 72 percent of physicians had adopted some type of system and that 40 percent had adopted capabilities required for a basic EHR system. The highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community health centers. As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty. However, small practices continued to lag behind larger practices. Finally, the majority of physicians who adopted the EHR capabilities required to obtain federal financial incentives used the capabilities routinely, with few differences across physician groups. PMID:23840050

  14. The Study of Electronic Medical Record Adoption in a Medicare Certified Home Health Agency Using a Grounded Theory Approach

    ERIC Educational Resources Information Center

    May, Joy L.

    2013-01-01

    The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences…

  15. Improving drug abuse treatment delivery through adoption of harmonized electronic health record systems.

    PubMed

    Ghitza, Udi E; Sparenborg, Steven; Tai, Betty

    2011-07-01

    A great divide currently exists between mainstream health care and specialty substance use disorders (SUD) treatment, concerning the coordination of care and sharing of medical information. Improving the coordination of SUD treatment with other disciplines of medicine will benefit SUD patients. The development and use of harmonized electronic health record systems (EHR) containing standardized person-level information will enable improved coordination of healthcare services. We attempt here to illuminate the urgent public health need to develop and implement at the national level harmonized EHR including data fields containing standardized vocabulary/terminologies relevant to SUD treatment. The many advantages and barriers to harmonized EHR implementation in SUD treatment service groups, and pathways to their successful implementation, are also discussed. As the US Federal Government incentivizes Medicare and Medicaid Service providers nationwide for "meaningful use" of health information technology (HIT) systems, relevant stakeholders may face relatively large and time-consuming processes to conform their local practices to meet the federal government's "meaningful use" criteria unless they proactively implement data standards and elements consistent with those criteria. Incorporating consensus-based common data elements and standards relevant to SUD screening, diagnosis, and treatment into the federal government's "meaningful use" criteria is an essential first step to develop necessary infrastructure for effective coordination of HIT systems among SUD treatment and other healthcare service providers to promote collaborative-care implementation of cost-effective, evidence-based treatments and to support program evaluations.

  16. Administrative simplification: adoption of operating rules for health care electronic funds transfers (EFT) and remittance advice transactions. Interim final rule with comment period.

    PubMed

    2012-08-10

    This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of operating rules for the health care electronic funds transfers (EFT) and remittance advice transaction. PMID:22888504

  17. Travelers' Health: International Adoption

    MedlinePlus

    ... preadoption living standards, varying disease epidemiology in the countries of origin, the presence of previously unidentified medical problems, and ... know the disease risks in the adopted child’s country of origin and the medical and social histories of the ...

  18. 77 FR 1555 - Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-10

    ... regulatory history, see the August 22, 2008 (73 FR 49742) proposed rule entitled ``Health Insurance Reform..., 2000 Federal Register (65 FR 50312), we published a final rule entitled ``Health Insurance Reform... Standards'' (74 FR 3296) (hereinafter referred to as the Modifications final rule) that, among other...

  19. Health insurance reform; announcement of maintenance changes to electronic data transaction standards adopted under the Health Insurance Portability and Accountability Act of 1996. Notification.

    PubMed

    2010-10-13

    This document announces maintenance changes to some of the Health Insurance Portability and Accountability Act of 1996 standards made by the Designated Standard Maintenance Organizations. The maintenance changes are non-substantive changes to correct minor errors, such as typographical errors, or to provide clarifications of the standards adopted in our regulations entitled "Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards," published in the Federal Register on January 16, 2009. This document also instructs interested persons on how to obtain the corrections. PMID:20941887

  20. Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments.

    PubMed

    Ben-Assuli, Ofir

    2015-03-01

    Recently, the healthcare sector has shown a growing interest in information technologies. Two popular health IT (HIT) products are the electronic health record (EHR) and health information exchange (HIE) networks. The introduction of these tools is believed to improve care, but has also raised some important questions and legal and privacy issues. The implementation of these systems has not gone smoothly, and still faces some considerable barriers. This article reviews EHR and HIE to address these obstacles, and analyzes the current state of development and adoption in various countries around the world. Moreover, legal and ethical concerns that may be encountered by EHR users and purchasers are reviewed. Finally, links and interrelations between EHR and HIE and several quality of care issues in today's healthcare domain are examined with a focus on EHR and HIE in the emergency department (ED), whose unique characteristics makes it an environment in which the implementation of such technology may be a major contributor to health, but also faces substantial challenges. The paper ends with a discussion of specific policy implications and recommendations based on an examination of the current limitations of these systems.

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

    PubMed Central

    2012-01-01

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

  2. Electronic Dental Records System Adoption.

    PubMed

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

    2015-01-01

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

  3. Drivers and Barriers in Health IT Adoption

    PubMed Central

    Avgar, A.C.; Litwin, A.S.; Pronovost, P.J.

    2012-01-01

    Despite near (and rare) consensus that the adoption and diffusion of health information technology (health IT) will bolster outcomes for organizations, individuals, and the healthcare system as a whole, there has been surprisingly little consideration of the structures and processes within organizations that might drive the adoption and effective use of the technology. Management research provides a useful lens through which to analyze both the determinants of investment and the benefits that can ultimately be derived from these investments. This paper provides a conceptual framework for understanding health IT adoption. In doing so, this paper highlights specific organizational barriers or enablers at different stages of the adoption process – investment, implementation, and use – and at different levels of organizational decision-making – strategic, operational, and frontline. This framework will aid both policymakers and organizational actors as they make sense of the transition from paper-based to electronic systems. PMID:23646093

  4. Reproductive health professionals' adoption of emerging technologies for health promotion.

    PubMed

    Smith, Peggy B; Buzi, Ruth S

    2014-12-01

    The purpose of this study was to assess reproductive health professionals' familiarity with and use of various electronic technologies to support health promotion. The study also examined the relationship between demographic characteristics and attitudes and beliefs of the effectiveness of new technologies and perceived barriers for usage. A total of 165 reproductive health professionals at two conferences related to reproductive health in the United States completed the study survey. Personal and organizational factors affected the adoption of electronic technologies for health promotion. This included lack of knowledge, skills, and confidence as well as privacy concerns. The results of the study also suggested that being from an older generation was associated with having lower levels of knowledge, skills, and confidence in using new media. These findings highlight the importance of creating learning opportunities on the use of new technology for health promotion as well as addressing specific perceived barriers among reproductive health professionals in order to promote the adoption of these technologies. PMID:25411221

  5. Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation

    PubMed Central

    Robertson, Ann; Cresswell, Kathrin; Takian, Amirhossein; Petrakaki, Dimitra; Crowe, Sarah; Cornford, Tony; Barber, Nicholas; Avery, Anthony; Fernando, Bernard; Jacklin, Ann; Prescott, Robin; Klecun, Ela; Paton, James; Lichtner, Valentina; Quinn, Casey; Ali, Maryam; Morrison, Zoe; Jani, Yogini; Waring, Justin; Marsden, Kate

    2010-01-01

    Objectives To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service. Design A mixed methods, longitudinal, multisite, socio-technical case study. Setting Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete. Data sources and analysis Dataset for the evaluation consists of semi-structured interviews, documents and field notes, observations, and quantitative data. Qualitative data were analysed thematically with a socio-technical coding matrix, combined with additional themes that emerged from the data. Main results Hospital electronic health record applications are being developed and implemented far more slowly than was originally envisioned; the top-down, standardised approach has needed to evolve to admit more variation and greater local choice, which hospital trusts want in order to support local activity. Despite considerable delays and frustrations, support for electronic health records remains strong, including from NHS clinicians. Political and financial factors are now perceived to threaten nationwide implementation of electronic health records. Interviewees identified a range of consequences of long term, centrally negotiated contracts to deliver the NHS Care Records Service in secondary care, particularly as NHS trusts themselves are not party to these contracts. These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities. Our data suggest support for a “middle-out” approach to implementing hospital electronic health records, combining government direction with increased local autonomy, and for restricting

  6. Health Care Information Technology in Rural America: Electronic Medical Record Adoption Status in Meeting the National Agenda

    ERIC Educational Resources Information Center

    Bahensky, James A.; Jaana, Mirou; Ward, Marcia M.

    2008-01-01

    Continuing is a national political drive for investments in health care information technology (HIT) that will allow the transformation of health care for quality improvement and cost reduction. Despite several initiatives by the federal government to spur this development, HIT implementation has been limited, particularly in the rural market. The…

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

    ERIC Educational Resources Information Center

    Akpabio, Akpabio Enebong Ema

    2013-01-01

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

  8. Progress in electronic medical record adoption in Canada

    PubMed Central

    Chang, Feng; Gupta, Nishi

    2015-01-01

    Objective To determine the rate of adoption of electronic medical records (EMRs) by physicians across Canada, provincial incentives, and perceived benefits of and barriers to EMR adoption. Data sources Data on EMR adoption in Canada were collected from CINAHL, MEDLINE, PubMed, EMBASE, the Cochrane Library, the Health Council of Canada, Canada Health Infoway, government websites, regional EMR associations, and health professional association websites. Study selection After removal of duplicate articles, 236 documents were found matching the original search. After using the filter Canada, 12 documents remained. Additional documents were obtained from each province’s EMR website and from the Canada Health Infoway website. Synthesis Since 2006, Canadian EMR adoption rates have increased from about 20% of practitioners to an estimated 62% of practitioners in 2013, with substantial regional disparities ranging from roughly 40% of physicians in New Brunswick and Quebec to more than 75% of physicians in Alberta. Provincial incentives vary widely but appear to have only a weak relationship with the rate of adoption. Many adopters use only a fraction of their software’s available functions. User-cited benefits to adoption include time savings, improved record keeping, heightened patient safety, and confidence in retrieved data when EMRs are used efficiently. Barriers to adoption include financial and time constraints, lack of knowledgeable support personnel, and lack of interoperability with hospital and pharmacy systems. Conclusion Canadian physicians remain at the stage of EMR adoption. Progression in EMR use requires experienced, knowledgeable technical support during implementation, and financial support for the transcription of patient data from paper to electronic media. The interoperability of EMR offerings for hospitals, pharmacies, and clinics is the rate-limiting factor in achieving a unified EMR solution for Canada. PMID:27035020

  9. Pricing Health Behavior Interventions to Promote Adoption

    PubMed Central

    Ribisl, Kurt M.; Leeman, Jennifer; Glasser, Allison M.

    2015-01-01

    The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed, whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact. PMID:24842743

  10. Managing the Challenges of Adopting Electronic Medical Records: An Exploratory Study of the Challenges Faced by African American Health Care Professionals

    ERIC Educational Resources Information Center

    Riddick, William P.

    2013-01-01

    The implementation of technology within the health care industry is viewed as a possible solution for lowering costs and improving health care delivery to patients. Electronic medical record system(s) (EMRS) are information technology tools viewed within the health care industry as a possible solution for aiding improvements in health care…

  11. [International adoption: children's health risk evolution].

    PubMed

    Dartiguenave, C

    2012-05-01

    The socioeconomic and sanitary conditions in many countries make it necessary to weigh as precisely as possible the uncertainties which might affect the health of internationally adopted children, which is one of the key drivers to adoption decision. Indeed, health troubles are more and more frequent among children proposed by countries, at a time when there are fewer children to be adopted. Hence the institutions and the actors in the field of international adoption are compelled to frequently update their professional practices, so as to cope both with the declining offer for adoptable children and with the increasing pressure from the birth countries of children to make host countries adopt children with high age or with special needs. It also requires from the administrations the will to provide better initial information and to implement the demand for an agreement. Meanwhile, in spite of those growing constraints, adopting families have been more and more risk adverse during the latest decades, this being a common trend in our developed countries.

  12. Quality and Electronic Health Records in Community Health Centers

    ERIC Educational Resources Information Center

    Lesh, Kathryn A.

    2014-01-01

    Adoption and use of health information technology, the electronic health record (EHR) in particular, has the potential to help improve the quality of care, increase patient safety, and reduce health care costs. Unfortunately, adoption and use of health information technology has been slow, especially when compared to the adoption and use of…

  13. Key success factors behind electronic medical record adoption in Thailand.

    PubMed

    Narattharaksa, Kanida; Speece, Mark; Newton, Charles; Bulyalert, Damrongsak

    2016-09-19

    Purpose The purpose of this paper is to investigate the elements that health care personnel in Thailand believe are necessary for successful adoption of electronic medical record (EMR) systems. Design/methodology/approach Initial qualitative in-depth interviews with physicians to adapt key elements from the literature to the Thai context. The 12 elements identified included things related to managing the implementation and to IT expertise. The nationwide survey was supported by the Ministry of Public Health and returned 1,069 usable questionnaires (response rate 42 percent) from a range of medical personnel. Findings The key elements clearly separated into a managerial dimension and an IT dimension. All were considered fairly important, but managerial expertise was more critical. In particular, there should be clear EMR project goals and scope, adequate budget allocation, clinical staff must be involved in implementation, and the IT should facilitate good electronic communication. Research limitations/implications Thailand is representative of middle-income developing countries, but there is no guarantee findings can be generalized. National policies differ, as do economic structures of health care industries. The focus is on management at the organizational level, but future research must also examine macro-level issues, as well as gain more depth into thinking of individual health care personnel. Practical implications Technical issues of EMR implementation are certainly important. However, it is clear actual adoption and use of the system also depends very heavily on managerial issues. Originality/value Most research on EMR implementation has been in developed countries, and has often focussed more on technical issues rather than examining managerial issues closely. Health IT is also critical in developing economies, and management of health IT implementation must be well understood. PMID:27681029

  14. Key success factors behind electronic medical record adoption in Thailand.

    PubMed

    Narattharaksa, Kanida; Speece, Mark; Newton, Charles; Bulyalert, Damrongsak

    2016-09-19

    Purpose The purpose of this paper is to investigate the elements that health care personnel in Thailand believe are necessary for successful adoption of electronic medical record (EMR) systems. Design/methodology/approach Initial qualitative in-depth interviews with physicians to adapt key elements from the literature to the Thai context. The 12 elements identified included things related to managing the implementation and to IT expertise. The nationwide survey was supported by the Ministry of Public Health and returned 1,069 usable questionnaires (response rate 42 percent) from a range of medical personnel. Findings The key elements clearly separated into a managerial dimension and an IT dimension. All were considered fairly important, but managerial expertise was more critical. In particular, there should be clear EMR project goals and scope, adequate budget allocation, clinical staff must be involved in implementation, and the IT should facilitate good electronic communication. Research limitations/implications Thailand is representative of middle-income developing countries, but there is no guarantee findings can be generalized. National policies differ, as do economic structures of health care industries. The focus is on management at the organizational level, but future research must also examine macro-level issues, as well as gain more depth into thinking of individual health care personnel. Practical implications Technical issues of EMR implementation are certainly important. However, it is clear actual adoption and use of the system also depends very heavily on managerial issues. Originality/value Most research on EMR implementation has been in developed countries, and has often focussed more on technical issues rather than examining managerial issues closely. Health IT is also critical in developing economies, and management of health IT implementation must be well understood.

  15. To promote adoption of household health technologies, think beyond health.

    PubMed

    Thurber, Mark C; Warner, Christina; Platt, Lauren; Slaski, Alexander; Gupta, Rajesh; Miller, Grant

    2013-10-01

    Health risks from poor malaria control, unsafe water, and indoor air pollution are responsible for an important share of the global disease burden-and they can be addressed by efficacious household health technologies that have existed for decades. However, coverage rates of these products among populations at risk remain disappointingly low. We conducted a review of the medical and public health literatures and found that health considerations alone are rarely sufficient motivation for households to adopt and use these technologies. In light of these findings, we argue that health education and persuasion campaigns by themselves are unlikely to be adequate. Instead, health policymakers and professionals must understand what users value beyond health and possibly reengineer health technologies with these concerns in mind. PMID:23948003

  16. To Promote Adoption of Household Health Technologies, Think Beyond Health

    PubMed Central

    Warner, Christina; Platt, Lauren; Slaski, Alexander; Gupta, Rajesh; Miller, Grant

    2013-01-01

    Health risks from poor malaria control, unsafe water, and indoor air pollution are responsible for an important share of the global disease burden—and they can be addressed by efficacious household health technologies that have existed for decades. However, coverage rates of these products among populations at risk remain disappointingly low. We conducted a review of the medical and public health literatures and found that health considerations alone are rarely sufficient motivation for households to adopt and use these technologies. In light of these findings, we argue that health education and persuasion campaigns by themselves are unlikely to be adequate. Instead, health policymakers and professionals must understand what users value beyond health and possibly reengineer health technologies with these concerns in mind. PMID:23948003

  17. Should health care managers adopt Theory Z?

    PubMed

    Safranski, S R; Kwon, I W; Walker, W R; Unger, M

    1986-04-01

    Health care administrators should carefully consider the situations in which they apply management methods used in industry, since such methods may not be effective in motivating certain groups of hospital employees. Physicians, for example, may display little loyalty to the health care organization, even though as a group they exert significant influence on policies, standards, and administration. As a result, management styles such as Theory Z that focus on holistic concern, individual decision-making responsibility, and long-term employment guarantees may fail to interest them. Nurses also may be reluctant to commit themselves to an organization because of the high rate of turnover in their profession in recent years. Support staff, however, probably would be receptive to management techniques that offer security through long-term employment guarantees. Other factors necessary for the effective use of Theory Z industrial management techniques are a clear hierarchy with well-defined reporting relationships, moderately specialized career paths, and trust among employees that the organization's concern for their welfare is genuine. The key consideration, however, in applying any theory is that only those aspects which best serve the organization's needs should be adopted.

  18. Investment subsidies and the adoption of electronic medical records in hospitals.

    PubMed

    Dranove, David; Garthwaite, Craig; Li, Bingyang; Ody, Christopher

    2015-12-01

    In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH.

  19. Personal health records: key adoption issues and implications for management.

    PubMed

    Raisinghani, Mahesh S; Young, Erika

    2008-01-01

    Electronic Personal Health Records (PHRs) has been perceived as the tool to empower consumers to become active decision-makers of their healthcare instead of leaving the decision to providers. However, there has been the lack of enthusiasm and adoption of PHRs. This paper examines the current healthcare climate and attempts to understand the major challenges associated with PHRs adoption. The paper-based and fragmented healthcare system is no longer appropriate for the digital economy of the 21st century. The integrated health information technology system is the solution to transform clinical practice to consumer centric and information driven. Tools such as PHRs are means to an end that provide better, safer and more affordable healthcare for consumers. However, there has been little research conducted to demonstrate PHR's tangible value, despite the widespread perceived value of these technologies. Although survey data reveals that there is a lack of awareness among the public, consumers are receptive to this concept, especially when a physician recommends it. Key issues in adopting PHRs and strategies for successful implementation of PHRs are discussed.

  20. Electronic Medical Records Adoption and Usage among Osteopathic Physicians in New York State

    ERIC Educational Resources Information Center

    Rosenthal, Jon I.

    2012-01-01

    In 2010, the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology reported a slow rate of adoption of electronic medical records. The present research sought to explore possible reasons for this situation by examining factors that distinguished between users and nonusers of electronic…

  1. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals

    PubMed Central

    Cornford, Tony; Barber, Nicholas; Avery, Anthony; Takian, Amirhossein; Lichtner, Valentina; Petrakaki, Dimitra; Crowe, Sarah; Marsden, Kate; Robertson, Ann; Morrison, Zoe; Klecun, Ela; Prescott, Robin; Quinn, Casey; Jani, Yogini; Ficociello, Maryam; Voutsina, Katerina; Paton, James; Fernando, Bernard; Jacklin, Ann; Cresswell, Kathrin

    2011-01-01

    Objectives To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England. Design Theoretically informed, longitudinal qualitative evaluation based on case studies. Setting 12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years. Data sources Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents. Results Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS

  2. Adoption

    MedlinePlus

    ... the birth nor adoptive parents know the others' identities. Other adoptions are handled more openly. Open adoptions, ... desire to seek out more information about the identity of the birth family. Most of us (whether ...

  3. Adopting feminist strategies to improve women's health.

    PubMed

    James, T

    The new public health movement offers community nurses a context in which to address the continuing inequalities faced by women in society. This paper explores the use of feminism as a tool for this. It considers some of the constraints on feminist nursing practice and offers some ways forward.

  4. Perspectives on electronic medical records adoption: electronic medical records (EMR) in outcomes research.

    PubMed

    Belletti, Dan; Zacker, Christopher; Mullins, C Daniel

    2010-07-01

    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 medical record (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 medical record 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.

  5. Factors influencing the adoption of health information technologies: a systematic review

    PubMed Central

    Garavand, Ali; Mohseni, Mohammah; Asadi, Heshmatollah; Etemadi, Manal; Moradi-Joo, Mohammad; Moosavi, Ahmad

    2016-01-01

    Introduction The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. Methods This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004–2014 period. Results The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. Conclusion By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased. PMID:27757179

  6. Nurses' Perceptions of the Electronic Health Record

    ERIC Educational Resources Information Center

    Crawley, Rocquel Devonne

    2013-01-01

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

  7. Health information systems adoption: findings from a systematic review.

    PubMed

    Yusof, Maryati Mohd; Stergioulas, Lampros; Zugic, Jasmina

    2007-01-01

    Earlier evaluation studies on Health Information Systems (HIS) adoption have highlighted a large number of adoption problems that were attributed to the lack of fit between technology, human and organisation factors. Lessons can be learned from these evaluation studies by identifying the most important factors of HIS adoption. In order to study the adoption issue, a qualitative systematic review has been performed using a recently introduced framework, known as HOT-fit (Human, Organisation and Technology fit). The paper identifies and highlights the following critical adoption factors: technology (ease of use, system usefulness, system flexibility, time efficiency, information accessibility and relevancy); human (user training, user perception, user roles, user skills, clarity of system purpose, user involvement); organisation (leadership and support, clinical process, user involvement, internal communication, inter organisational system, as well as the fit between them. The findings can be used to guide future system development and inform relevant decision making. PMID:17911719

  8. Understanding Electronic Medical Record Adoption in the United States: Communication and Sociocultural Perspectives

    PubMed Central

    Kreps, Gary L; Polit, Stan

    2013-01-01

    Background This paper adopts a communication and sociocultural perspective to analyze the factors behind the lag in electronic medical record (EMR) adoption in the United States. Much of the extant research on this topic has emphasized economic factors, particularly, lack of economic incentives, as the primary cause of the delay in EMR adoption. This prompted the Health Information Technology on Economic and Clinical Health Act that allow financial incentives through the Centers of Medicare and Medicaid Services for many health care organizations planning to adopt EMR. However, financial incentives alone have not solved the problem; many new innovations do not diffuse even when offered for free. Thus, this paper underlines the need to consider communication and sociocultural factors to develop a better understanding of the impediments of EMR adoption. Objective The objective of this paper was to develop a holistic understanding of EMR adoption by identifying and analyzing the impact of communication and sociocultural factors that operate at 3 levels: macro (environmental), meso (organizational), and micro (individual). Methods We use the systems approach to focus on the 3 levels (macro, meso, and micro) and developed propositions at each level drawing on the communication and sociocultural perspectives. Results Our analysis resulted in 10 propositions that connect communication and sociocultural aspects with EMR adoption. Conclusions This paper brings perspectives from the social sciences that have largely been missing in the extant literature of health information technology (HIT) adoption. In doing so, it implies how communication and sociocultural factors may complement (and in some instances, reinforce) the impact of economic factors on HIT adoption. PMID:23612390

  9. Social Media Adoption in Local Health Departments Nationwide

    PubMed Central

    Mueller, Nancy L.; Snider, Doneisha

    2013-01-01

    Objectives. We examined whether characteristics of local health departments (LHD) and their geographic region were associated with using Facebook and Twitter. We also examined the number of tweets per month for Twitter accounts as an indicator of social media use by LHDs. Methods. In 2012, we searched for Facebook and Twitter accounts for 2565 LHDs nationwide, and collected adoption date and number of connections for each account. Number of tweets sent indicated LHD use of social media. LHDs were classified as innovators, early adopters, or nonadopters. Characteristics of LHDs were compared across adoption categories, and we examined geographic characteristics, connections, and use. Results. Twenty-four percent of LHDs had Facebook, 8% had Twitter, and 7% had both. LHDs serving larger populations were more likely to be innovators, tweeted more often, and had more social media connections. Frequency of tweeting was not associated with adoption category. There were differences in adoption across geographic regions, with western states more likely to be innovators. Innovation was also higher in states where the state health department adopted social media. Conclusions. Social media has the potential to aid LHDs in disseminating information across the public health system. More evidence is needed to develop best practices for this emerging tool. PMID:23865660

  10. Factors Affecting Electronic Medical Record System Adoption in Small Korean Hospitals

    PubMed Central

    Park, Young-Taek

    2014-01-01

    Objectives The objective of this paper is to investigate the factors affecting adoption of an Electronic Medical Record (EMR) system in small Korean hospitals. Methods This study used survey data on adoption of EMR systems; data included that from various hospital organizational structures. The survey was conducted from April 10 to August 3, 2009. The response rate was 33.5% and the total number of small general hospitals was 144. Data were analyzed using the generalized estimating equation method to adjust for environmental clustering effects. Results The adoption rate of EMR systems was 40.2% for all responding small hospitals. The study results indicate that IT infrastructure (OR, 1.48; 95% CI, 1.23 to 1.80) and organic hospital structure (OR, 1.86; 95% CI, 1.07 to 3.23) rather than mechanistic hospital structure or the number of hospitals within a county (OR, 1.08; 95% CI, 1.01 to 1.17) were critical factors for EMR adoption after controlling for various hospital covariates. Conclusions This study found that several managerial features of hospitals and one environmental factor were related to the adoption of EMR systems in small Korean hospitals. Considering that health information technology produces many positive health outcomes and that an 'adoption gap' regarding information technology exists in small clinical settings, healthcare policy makers should understand which organizational and environmental factors affect adoption of EMR systems and take action to financially support small hospitals during this transition. PMID:25152831

  11. Health information technology adoption in U.S. acute care hospitals.

    PubMed

    Zhang, Ning Jackie; Seblega, Binyam; Wan, Thomas; Unruh, Lynn; Agiro, Abiy; Miao, Li

    2013-04-01

    Previous studies show that the healthcare industry lags behind many other economic sectors in the adoption of information technology. The purpose of this study is to understand differences in structural characteristics between providers that do and that do not adopt Health Information Technology (HIT) applications. Publicly available secondary data were used from three sources: American Hospital Association (AHA) annual survey, Healthcare Information and Management Systems Society (HIMSS) analytics annual survey, and Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) databases. Fifty-two information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. Negative binomial regression was applied with adoption of technology as the dependent variables and eight organizational and contextual factors as the independent variables. Hospitals adopt a relatively larger proportion of administrative information technology as compared to clinical and strategic IT. Large size, urban location and HMO penetration were found to be the most influential hospital characteristics that positively affect information technology adoption. There are still considerable variations in the adoption of information technology across hospitals and in the type of technology adopted. Organizational factors appear to be more influential than market factors when it comes to information technology adoption. The future research may examine whether the Electronic Health Record (EHR) Incentive Program in 2011 would increase the information technology uses in hospitals as it provides financial incentives for HER adoptions and uses among providers.

  12. What Constitutes Adoption of the Web: A Methodological Problem in Assessing Adoption of the World Wide Web for Electronic Commerce.

    ERIC Educational Resources Information Center

    White, Marilyn Domas; Abels, Eileen G.; Gordon-Murnane, Laura

    1998-01-01

    Reports on methodological developments in a project to assess the adoption of the Web by publishers of business information for electronic commerce. Describes the approach used on a sample of 20 business publishers to identify five clusters of publishers ranging from traditionalist to innovator. Distinguishes between adopters and nonadopters of…

  13. Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide

    PubMed Central

    Mabry-Flynn, Amanda; Champlin, Sara; Donovan, Erin E; Pounders, Kathrynn

    2016-01-01

    Background Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. Objective The purpose of this study was to determine whether health literacy is associated with patients’ use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of these HIT tools, as well as patients’ perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. Methods Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. Results Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics

  14. Creating a survey to assess physicians' adoption of health information technology.

    PubMed

    Baier, Rosa R; Gardner, Rebekah L; Buechner, Jay S; Harris, Yael; Viner-Brown, Samara; Gifford, Deidre S

    2012-04-01

    Information on state-level health information technology (HIT) adoption will become increasingly important with the implementation of incentive payments to accelerate uptake. Recognizing this, the Rhode Island Department of Health selected physician HIT adoption as a subject for its legislatively mandated quality reporting program. This article discusses the state's process for developing HIT adoption measures, including the importance of stakeholder involvement in the development of a survey and the difficulty of accurately defining electronic medical record (EMR) adoption. This article describes the challenges in defining "true" EMRs, which may be addressed, in part, by ensuring local consensus about EMR measures and by piloting the survey and measures, prior to public reporting or the calculation of a statewide baseline. It also presents results from the 2009 administration of this survey to all 3,883 Rhode Island-licensed physicians providing direct patient care.

  15. Adoption of Clinical Information Systems in Health Services Organizations

    PubMed Central

    Austin, Charles J.; Holland, Gloria J.

    1988-01-01

    This paper presents a conceptual model of factors which influence organizational decisions to invest in the installation of clinical information systems. Using results of previous research as a framework, the relative influence of clinical, fiscal, and strategic-institutional decision structures are examined. These adoption decisions are important in health services organizations because clinical information is essential for managing demand and allocating resources, managing quality of care, and controlling costs.

  16. Electronic health records for cardiovascular medicine.

    PubMed

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

    2014-01-01

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

  17. The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems.

    PubMed

    Price, Morgan; Lau, Francis

    2014-01-01

    Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers. PMID:24884588

  18. Factors Associated With Adoption of Health Information Technology: A Conceptual Model Based on a Systematic Review

    PubMed Central

    DeShazo, Jonathan; Kim, Forest; Fulton, Lawrence

    2014-01-01

    Background The Health Information Technology for Economic and Clinical Health Act (HITECH) allocated $19.2 billion to incentivize adoption of the electronic health record (EHR). Since 2009, Meaningful Use Criteria have dominated information technology (IT) strategy. Health care organizations have struggled to meet expectations and avoid penalties to reimbursements from the Center for Medicare and Medicaid Services (CMS). Organizational theories attempt to explain factors that influence organizational change, and many theories address changes in organizational strategy. However, due to the complexities of the health care industry, existing organizational theories fall short of demonstrating association with significant health care IT implementations. There is no organizational theory for health care that identifies, groups, and analyzes both internal and external factors of influence for large health care IT implementations like adoption of the EHR. Objective The purpose of this systematic review is to identify a full-spectrum of both internal organizational and external environmental factors associated with the adoption of health information technology (HIT), specifically the EHR. The result is a conceptual model that is commensurate with the complexity of with the health care sector. Methods We performed a systematic literature search in PubMed (restricted to English), EBSCO Host, and Google Scholar for both empirical studies and theory-based writing from 1993-2013 that demonstrated association between influential factors and three modes of HIT: EHR, electronic medical record (EMR), and computerized provider order entry (CPOE). We also looked at published books on organizational theories. We made notes and noted trends on adoption factors. These factors were grouped as adoption factors associated with various versions of EHR adoption. Results The resulting conceptual model summarizes the diversity of independent variables (IVs) and dependent variables (DVs) used

  19. Influences on physicians' adoption of electronic detailing (e-detailing).

    PubMed

    Alkhateeb, Fadi M; Doucette, William R

    2009-01-01

    E-detailing means using digital technology: internet, video conferencing and interactive voice response. There are two types of e-detailing: interactive (virtual) and video. Currently, little is known about what factors influence physicians' adoption of e-detailing. The objectives of this study were to test a model of physicians' adoption of e-detailing and to describe physicians using e-detailing. A mail survey was sent to a random sample of 2000 physicians practicing in Iowa. Binomial logistic regression was used to test the model of influences on physician adoption of e-detailing. On the basis of Rogers' model of adoption, the independent variables included relative advantage, compatibility, complexity, peer influence, attitudes, years in practice, presence of restrictive access to traditional detailing, type of specialty, academic affiliation, type of practice setting and control variables. A total of 671 responses were received giving a response rate of 34.7%. A total of 141 physicians (21.0%) reported using of e-detailing. The overall adoption model for using either type of e-detailing was found to be significant. Relative advantage, peer influence, attitudes, type of specialty, presence of restrictive access and years of practice had significant influences on physician adoption of e-detailing. The model of adoption of innovation is useful to explain physicians' adoption of e-detailing. PMID:19306198

  20. WTO ministerial conference adopts declaration on TRIPS and public health.

    PubMed

    Elliott, Richard

    2002-03-01

    In November 2001, the 4th Ministerial Conference of the World Trade Organization adopted a Ministerial Declaration on public health and the WTO's Agreement on Trade-Related Aspects of Intellectual Property Rights (the "TRIPS Agreement"). The declaration represents a modest advance in addressing concerns that strict patent laws, and threats of trade sanctions, will be a barrier to most of the world's people with HIV/AIDS accessing affordable medicines. The full significance of the declaration remains to be seen, as it depends on what political impact it has at the WTO and on its member countries, and what legal impact it will have in the interpretation of the TRIPS Agreement.

  1. "Willing but unwilling": attitudinal barriers to adoption of home-based health information technology among older adults.

    PubMed

    Young, Rachel; Willis, Erin; Cameron, Glen; Geana, Mugur

    2014-06-01

    While much research focuses on adoption of electronic health-care records and other information technology among health-care providers, less research explores patient attitudes. This qualitative study examines barriers to adoption of home-based health information technology, particularly personal electronic health records, among older adults. We conducted in-depth interviews (30-90 min duration) with 35 American adults, aged 46-72 years, to determine their perceptions of and attitudes toward home-based health information technology. Analysis of interview data revealed that most barriers to adoption fell under four themes: technological discomfort, privacy or security concerns, lack of relative advantage, and perceived distance from the user representation. Based on our findings, systems to promote home-based health information technology should incorporate familiar computer applications, alleviate privacy and security concerns, and align with older adults' active and engaged self-image.

  2. Electronic health record and electronic patient record.

    PubMed

    Dimond, Bridgit

    This article considers the government plans for the development of electronic health and patient records as set out in the NHS Plan and the progress and problems which have been encountered in their realization. PMID:16116372

  3. Electronic Learning Systems in Hong Kong Business Organizations: A Study of Early and Late Adopters

    ERIC Educational Resources Information Center

    Chan, Simon C. H.; Ngai, Eric W. T.

    2012-01-01

    Based on the diffusion of innovation theory (E. M. Rogers, 1983, 1995), the authors examined the antecedents of the adoption of electronic learning (e-learning) systems by using a time-based assessment model (R. C. Beatty, J. P. Shim, & M. C. Jones, 2001), which classified adopters into categories upon point in time when adopting e-learning…

  4. Despite substantial progress In EHR adoption, health information exchange and patient engagement remain low in office settings.

    PubMed

    Furukawa, Michael F; King, Jennifer; Patel, Vaishali; Hsiao, Chun-Ju; Adler-Milstein, Julia; Jha, Ashish K

    2014-09-01

    The United States is making substantial investments to accelerate the adoption and use of interoperable electronic health record (EHR) systems. Using data from the 2009-13 Electronic Health Records Survey, we found that EHR adoption continues to grow: In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non-primary care specialties lagging behind others. Physicians' electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization. Finally, we found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record. These findings suggest that although EHR adoption continues to grow, policies to support health information exchange and patient engagement will require ongoing attention. PMID:25104827

  5. Health benefits and risk associated with adopting a vegetarian diet.

    PubMed

    Pilis, Wiesław; Stec, Krzysztof; Zych, Michał; Pilis, Anna

    2014-01-01

    A vegetarian diet may be adopted for various reasons that can include ecological, economic, religious, ethical and health considerations. In the latter case they arise from the desire to lose weight, in tackling obesity, improving physical fitness and/or in reducing the risk of acquiring certain diseases. It has been shown that properly applied vegetarian diet is the most effective way of reducing body mass (expressed as BMI), improving the plasma lipid profile and in decreasing the incidence of high arterial blood pressure, cardiovascular disease, stroke, metabolic syndrome and arteriosclerosis. In addition, improved insulin sensitivity together with lower rates of diabetes and cancer has been observed. Some studies have however found that a vegetarian diet may result in changes adversely affecting the body. These could include; hyperhomocysteinaemia, protein deficiency, anaemia, decreased creatinine content in muscles and menstrual disruption in women who undertake increased physical activity. Some of these changes may decrease the ability for performing activities that require physical effort. Nevertheless, on balance it can be reasonably concluded that the beneficial effects of a vegetarian diet significantly, by far, outweigh the adverse ones. It should also be noted that the term 'vegetarian diet' is not always clearly defined in the literature and it may include many dietary variations.

  6. Adoption of health information technology for medication safety in U.S. Hospitals, 2006.

    PubMed

    Furukawa, Michael F; Raghu, T S; Spaulding, Trent J; Vinze, Ajay

    2008-01-01

    Health information technology (IT) is regarded as an essential tool to improve patient safety, and a range of initiatives to address patient safety are under way. Using data from a comprehensive, national survey from HIMSS Analytics, we analyzed the extent of health IT adoption for medication safety in U.S. hospitals in 2006. Our findings indicate wide variation in health IT adoption by type of technology and geographic location. Hospital size, ownership, teaching status, system membership, payer mix, and accreditation status are associated with health IT adoption, although these relationships differ by type of technology. Hospitals in states with patient safety initiatives have greater adoption rates.

  7. Health Care Provider Adoption of eHealth: Systematic Literature Review

    PubMed Central

    Talaei-Khoei, Amir; Seale, Holly; Ray, Pradeep; MacIntyre, C Raina

    2013-01-01

    Background eHealth is an application of information and communication technologies across the whole range of functions that affect health. The benefits of eHealth (eg, improvement of health care operational efficiency and quality of patient care) have previously been documented in the literature. Health care providers (eg, medical doctors) are the key driving force in pushing eHealth initiatives. Without their acceptance and actual use, those eHealth benefits would be unlikely to be reaped. Objective To identify and synthesize influential factors to health care providers’ acceptance of various eHealth systems. Methods This systematic literature review was conducted in four steps. The first two steps facilitated the location and identification of relevant articles. The third step extracted key information from those articles including the studies’ characteristics and results. In the last step, identified factors were analyzed and grouped in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT). Results This study included 93 papers that have studied health care providers’ acceptance of eHealth. From these papers, 40 factors were identified and grouped into 7 clusters: (1) health care provider characteristics, (2) medical practice characteristics, (3) voluntariness of use, (4) performance expectancy, (5) effort expectancy, (6) social influence, and (7) facilitating or inhibiting conditions. Conclusions The grouping results demonstrated that the UTAUT model is useful for organizing the literature but has its limitations. Due to the complex contextual dynamics of health care settings, our work suggested that there would be potential to extend theories on information technology adoption, which is of great benefit to readers interested in learning more on the topic. Practically, these findings may help health care decision makers proactively introduce interventions to encourage acceptance of eHealth and may also assist health policy makers

  8. Predicting the use of electronic prescribing among early adopters in primary care

    PubMed Central

    Sicotte, Claude; Taylor, Laurel; Tamblyn, Robyn

    2013-01-01

    Abstract Objective To identify the factors that can predict physicians’ use of electronic prescribing. Design All primary care physicians who practised in a single geographic region in Quebec were invited to use a free, advanced, research-based electronic prescribing and drug management system. This natural experiment was studied with an expansion of the Technology Acceptance Model (TAM), which was used to explain early adopters’ use of this electronic prescribing technology. Setting Quebec city region. Participants A total of 61 primary care physicians who practised in a single geographic region where there was no electronic prescribing. Main outcome measures Actual use of electronic prescribing; physicians’ perceptions of and intentions to use electronic prescribing; physician and practice characteristics. Results During the 9-month study period, 61 primary care physicians located in 26 practice sites used electronic prescribing to write 15 160 electronic prescriptions for 18 604 patients. Physician electronic prescribing rates varied considerably, from a low of 0 to a high of 75 per 100 patient visits, with a mean utilization rate of 30 per 100 patient visits. Overall, 34% of the variance in the use of electronic prescribing was explained by the expanded TAM. Computer experience (P = .001), physicians’ information-acquisition style (P = .01), and mean medication use in the practice (P = .02) were significant predictors. Other TAM factors that generally predict new technology adoption (eg, intention to use, perceived ease of use, and perceived usefulness) were not predictive in this study. Conclusion The adoption of electronic prescribing was a highly challenging task, even among early adopters. The insight that this pilot study provides into the determinants of the adoption of electronic prescribing suggests that novel physician-related factors (eg, information-acquisition style) and practice-related variables (eg, prevalence of medication use) influence

  9. Electronic Health Services

    PubMed Central

    Khalil, Mounir M; Jones, Ray

    2007-01-01

    Information and communication technologies have made dramatic changes in our lives. Healthcare communities also made use of these technologies. Using computerized medical knowledge, electronic patients’ information and telecommunications a lot of applications are now established throughout the world. These include better ways of information management, remote education, telemedicine and public services. Yet, a lot of people don't know about these technologies and their applications. Understanding the concepts and ideologies behind these terms, knowing how they will be implemented, what is it like to use them and what benefit will be gained, are basic knowledge steps approaching these technologies. Difficulties using these services, especially in developing countries should not be neglected or underestimated. PMID:21503245

  10. Behavioral Health Providers and Electronic Health Records: An Exploratory Beliefs Elicitation and Segmentation Study

    ERIC Educational Resources Information Center

    Shank, Nancy

    2011-01-01

    The widespread adoption of electronic health records (EHRs) is a public policy strategy to improve healthcare quality and reduce accelerating health care costs. Much research has focused on medical providers' perceptions of EHRs, but little is known about those of behavioral health providers. This research was informed by the theory of reasoned…

  11. Gender Representation in an Electronic City Hall: Female Adoption of Santa Monica's PEN System.

    ERIC Educational Resources Information Center

    Collins-Jarvis, Lori A.

    1993-01-01

    Discussion of the use of electronic networking systems by women focuses on a study of their use of the Public Electronic Network (PEN) in Santa Monica (California). Characteristics of PEN that contributed to female adoption are described; gender, political participation, and motivation are examined; and future research is suggested. (46…

  12. How to make the fourth revolution: Human factors in the adoption of electronic instructional aids

    NASA Technical Reports Server (NTRS)

    Demerath, N. J.; Daniels, L. A.

    1973-01-01

    The prospects and problems of getting higher education in the United States (high school and above) to more fully utilize electronic technologies are examined. Sociological, psychological, and political factors are analyzed to determine the feasibility of adopting electronic instructional techniques. Differences in organizations, attitudes, and customs of different kinds of students, teachers, administrators, and publics are crucial factors in innovation.

  13. Health Data Standards and Adoption Process: Preliminary Findings of a Qualitative Study in Saudi Arabia

    ERIC Educational Resources Information Center

    Alkraiji, Abdullah; Jackson, Thomas; Murray, Ian

    2011-01-01

    Purpose: This paper seeks to carry out a critical study of health data standards and adoption process with a focus on Saudi Arabia. Design/methodology/approach: Many developed nations have initiated programs to develop, promote, adopt and customise international health data standards to the local needs. The current status of, and future plans for,…

  14. A National Study of Fluoride Mouthrinse Adoption: Implications for School Health Personnel.

    ERIC Educational Resources Information Center

    Coombs, Jeanne A.; And Others

    1983-01-01

    The ongoing adoption of school-based fluoride mouthrinse programs has provided the opportunity to study issues surrounding the adoption and implementation of health technology by public schools. This article reports data on and implications of the National Study on the Diffusion of Preventive Health Measures to Schools. (Authors/CJ)

  15. Administrative simplification: adoption of operating rules for eligibility for a health plan and health care claim status transactions. Interim final rule with comment period.

    PubMed

    2011-07-01

    Section 1104 of the Administrative Simplification provisions of the Patient Protection and Affordable Care Act (hereafter referred to as the Affordable Care Act) establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs. Specifically, in section 1104(b)(2) of the Affordable Care Act, Congress required the adoption of operating rules for the health care industry and directed the Secretary of Health and Human Services to "adopt a single set of operating rules for each transaction * * * with the goal of creating as much uniformity in the implementation of the electronic standards as possible." This interim final rule with comment period adopts operating rules for two Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions: eligibility for a health plan and health care claim status. This rule also defines the term "operating rules" and explains the role of operating rules in relation to the adopted transaction standards. In general, transaction standards adopted under HIPAA enable electronic data interchange through a common interchange structure, thus minimizing the industry's reliance on multiple formats. Operating rules, in turn, attempt to define the rights and responsibilities of all parties, security requirements, transmission formats, response times, liabilities, exception processing, error resolution and more, in order to facilitate successful interoperability between data systems of different entities. PMID:21739765

  16. Predicting Adoption of Telemedicine by VA Mental Health Professionals

    ERIC Educational Resources Information Center

    Pak, Wesley Chong Y.

    2013-01-01

    Providing primary health and specialty services to 3.4 million rural and highly rural veterans is a challenging task because of geographic barriers and the uneven distribution of rural healthcare providers. Although the Veterans Health Administration is hoping that technology such as telemedicine expands availability of specialties' access to…

  17. Organizational factors influencing health information technology adoption in long-term-care facilities.

    PubMed

    Wang, Tiankai; Wang, Yangmei; Moczygemba, Jackie

    2014-01-01

    Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary.

  18. Electronic health record: implementation across the Michigan Academic Consortium.

    PubMed

    Bostrom, Andrea C; Schafer, Patricia; Dontje, Kathy; Pohl, Joanne M; Nagelkerk, Jean; Cavanagh, Stephen J

    2006-01-01

    The Michigan Academic Consortium of academic nurse-managed primary care centers supported member sites to venture into computer-based advances with the potential to improve quality of health services and students' educational experiences. The experiences of this consortium as it incorporated electronic health records in tandem with an electronic patient management system at several of its member sites reveal the benefits and challenges of such an endeavor. The processes of selection, adoption, and implementation of the electronic health record are discussed in this article. Many lessons learned in the process are discussed.

  19. Mining Electronic Health Records using Linked Data.

    PubMed

    Odgers, David J; Dumontier, Michel

    2015-01-01

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

  20. Mining Electronic Health Records using Linked Data

    PubMed Central

    Odgers, David J.; Dumontier, Michel

    2015-01-01

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

  1. Mining Electronic Health Records using Linked Data.

    PubMed

    Odgers, David J; Dumontier, Michel

    2015-01-01

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

  2. Adoption of e-health technology by physicians: a scoping review

    PubMed Central

    de Grood, Chloe; Raissi, Aida; Kwon, Yoojin; Santana, Maria Jose

    2016-01-01

    Objective The goal of this scoping review was to summarize the current literature identifying barriers and opportunities that facilitate adoption of e-health technology by physicians. Design Scoping review. Setting MEDLINE, EMBASE, and PsycINFO databases as provided by Ovid were searched from their inception to July 2015. Studies captured by the search strategy were screened by two reviewers and included if the focus was on barriers and facilitators of e-health technology adoption by physicians. Results Full-text screening yielded 74 studies to be included in the scoping review. Within those studies, eleven themes were identified, including cost and liability issues, unwillingness to use e-health technology, and training and support. Conclusion Cost and liability issues, unwillingness to use e-health technology, and training and support were the most frequently mentioned barriers and facilitators to the adoption of e-health technology. Government-level payment incentives and privacy laws to protect health information may be the key to overcome cost and liability issues. The adoption of e-health technology may be facilitated by tailoring to the individual physician’s knowledge of the e-health technology and the use of follow-up sessions for physicians and on-site experts to support their use of the e-health technology. To ensure the effective uptake of e-health technologies, physician perspectives need to be considered in creating an environment that enables the adoption of e-health strategies. PMID:27536128

  3. Intensifying Innovation Adoption in Educational eHealth

    ERIC Educational Resources Information Center

    Rissanen, M. K.

    2014-01-01

    In demanding innovation areas such as eHealth, the primary emphasis is easily placed on the product and process quality aspects in the design phase. Customer quality may receive adequate attention when the target audience is well-defined. But if the multidimensional evaluative focus does not get enough space until the implementation phase, this…

  4. Behavioral health electronic medical record.

    PubMed

    Lawlor, Ted; Barrows, Erik

    2008-03-01

    The electronic medical record (EMR) will be an important part of the future of medical practice. Behavioral health treatment demands certain additions to the capabilities of a standard general medical EMR. The current focus on the quality management and financial aspects of the EMR are only initial examples of what this tool can do. It is important for behavioral health practitioners to understand that they must embrace this innovation and mold it into a product that serves their needs and the needs of their patients. An efficient and effective EMR will greatly assist the overall clinical enterprise in a number of important areas. PMID:18295041

  5. Electronic Textbooks: Antecedents of Students' Adoption and Learning Outcomes

    ERIC Educational Resources Information Center

    Terpend, Regis; Gattiker, Thomas F.; Lowe, Scott E.

    2014-01-01

    Faculty and students are increasingly faced with the opportunity to use electronic versions of textbooks (e-texts). Despite the advantages of e-texts and recent advances in technology, evidence suggests that students are still reluctant to adopt and use e-texts. This situation leads us to investigate two research questions: What factors contribute…

  6. Organizational Learning and Large-Scale Change: Adoption of Electronic Medical Records

    ERIC Educational Resources Information Center

    Chavis, Virginia D.

    2010-01-01

    Despite implementation of electronic medical record (EMR) systems in the United States and other countries, there is no organizational development model that addresses medical professionals' attitudes toward technology adoption in a learning organization. The purpose of this study was to assess whether a model would change those attitudes toward…

  7. Determinants of Taxpayers' Adoption of Electronic Filing Methods in Taiwan: An Exploratory Study

    ERIC Educational Resources Information Center

    Fu, Jen-Ruei; Chao, Wen-Pin; Farn, Cheng-Kiang

    2004-01-01

    Using the personal income tax filing as an example of e-governmental services, this paper seeks to develop an understanding of the factors that influence citizens' adoption of electronic tax-filing services based on empirical data gathered from a large-scale nationwide survey. The taxpayers' satisfaction and usage intention regarding the use of…

  8. A Survey of the Health, Sleep, and Development of Children Adopted from China

    ERIC Educational Resources Information Center

    Rettig, Michael A.; Mccarthy-Rettig, Kelly

    2006-01-01

    The health, development, and sleeping patterns of 240 children adopted from China were examined using a survey research approach. Eighty percent of the children were 18 months of age or younger when adopted, and 98 percent of the children were girls. Sixty-two percent of the children were reported to have been developmentally delayed at the time…

  9. The Reality of Rhetoric in Information Systems Adoption: A Case Study Investigation of the Uk National Health Service

    NASA Astrophysics Data System (ADS)

    Khan, Imran; Ferneley, Elaine

    The UK National Health Service is undergoing a tremendous IS -led change, the purpose of which is to create a service capable of meeting the demands of the 21st century. The aim of this paper is to examine the extent to which persuasive discourse, or rhetoric, influences and affects the adoption of information systems within the health sector. It seeks to explore the ways in which various actors use rhetoric to advance their own agendas and the impact this has on the system itself. As such, the paper seeks to contribute to diffusion research through the use of a case study analysis of the implementation of an Electronic Single Patient Care Record system within one UK Health Service Trust. The findings of the paper suggest that rhetoric is an important and effective persuasive tool, employed by system trainers to coax users into not only adopting the system but also using the system in a predefined manner.

  10. The Impacts of Electronic Health Record Implementation on the Health Care Workforce.

    PubMed

    Zeng, Xiaoming

    2016-01-01

    Health care organizations at various levels are transitioning into the new electronic era by implementing and adopting electronic health record systems. New job roles will be needed for this transition, and some current job roles will inevitably become obsolete due to the change. In addition to training new personnel to fill these new roles, the focus should also be on equipping the current health care workforce with knowledge and skills in health information technology and health informatics that will support their work and improve quality of care. PMID:26961833

  11. Electronic cigarettes: human health effects

    PubMed Central

    Callahan-Lyon, Priscilla

    2014-01-01

    Objective With the rapid increase in use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigarettes), users and non-users are exposed to the aerosol and product constituents. This is a review of published data on the human health effects of exposure to e-cigarettes and their components. Methods Literature searches were conducted through September 2013 using multiple electronic databases. Results Forty-four articles are included in this analysis. E-cigarette aerosols may contain propylene glycol, glycerol, flavourings, other chemicals and, usually, nicotine. Aerosolised propylene glycol and glycerol produce mouth and throat irritation and dry cough. No data on the effects of flavouring inhalation were identified. Data on short-term health effects are limited and there are no adequate data on long-term effects. Aerosol exposure may be associated with respiratory function impairment, and serum cotinine levels are similar to those in traditional cigarette smokers. The high nicotine concentrations of some products increase exposure risks for non-users, particularly children. The dangers of secondhand and thirdhand aerosol exposure have not been thoroughly evaluated. Conclusions Scientific evidence regarding the human health effects of e-cigarettes is limited. While e-cigarette aerosol may contain fewer toxicants than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive. Some evidence suggests that e-cigarette use may facilitate smoking cessation, but definitive data are lacking. No e-cigarette has been approved by FDA as a cessation aid. Environmental concerns and issues regarding non-user exposure exist. The health impact of e-cigarettes, for users and the public, cannot be determined with currently available data. PMID:24732161

  12. Biometrics for electronic health records.

    PubMed

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

    2010-10-01

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

  13. Biometrics for electronic health records.

    PubMed

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

    2010-10-01

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

  14. Pricing health behavior interventions to promote adoption: lessons from the marketing and business literature.

    PubMed

    Ribisl, Kurt M; Leeman, Jennifer; Glasser, Allison M

    2014-06-01

    The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact.

  15. Health insurance reform; modifications to the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards. Final rule.

    PubMed

    2009-01-16

    This final rule adopts updated versions of the standards for electronic transactions originally adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This final rule also adopts a transaction standard for Medicaid pharmacy subrogation. In addition, this final rule adopts two standards for billing retail pharmacy supplies and professional services, and clarifies who the "senders" and "receivers" are in the descriptions of certain transactions. PMID:19385110

  16. Predictors of the decision to adopt motivational interviewing in community health settings.

    PubMed

    Williams, Jessica Roberts; Blais, Marissa Puckett; Banks, Duren; Dusablon, Tracy; Williams, Weston O; Hennessy, Kevin D

    2014-07-01

    The purpose of this study is to concurrently examine the impact of individual and organizational characteristics on the decision to adopt the evidence-based practice (EBP) motivational interviewing (MI) among directors and staff (n = 311) in community health organizations (n = 92). Results from hierarchical linear modeling indicated that, at the individual level, attitudes toward EBPs and race each predicted directors' decisions to adopt, while gender predicted staff's decisionmaking. At the organizational level, organizational climate was inversely associated with both staff's and directors' decisions to adopt MI. Organizational barriers to implementing EBPs and use of reading materials and treatment manuals were related to directors' decision to adopt. Type of organization and staff attributes were associated with staff's decision to adopt. These findings underscore the need to tailor dissemination and implementation strategies to address differences between directors and staff in the adoption of EBPs.

  17. Evaluation of a randomized intervention to increase adoption of comparative effectiveness research by community health organizations.

    PubMed

    Williams, Jessica Roberts; Williams, Weston O; Dusablon, Tracy; Blais, Marissa Puckett; Tregear, Stephen J; Banks, Duren; PhD, Kevin D Hennessy

    2014-07-01

    This randomized controlled trial examined the influence of two strategies (informational packets alone and in conjunction with Webinars) aimed at increasing the adoption of motivational interviewing (MI), a patient-centered behavioral health practice supported by evidence from comparative effectiveness studies, among community health organizations responsible for delivering mental and behavioral health services. Data were obtained from 311 directors and staff across 92 community organizations. Hierarchical linear modeling was used to examine changes in decision to adopt MI. The mediating effects of multiple contextual variables were also examined. Results showed that both strategies positively influenced the decision to adopt. The positive impact on decision to adopt was significantly greater among individuals that received informational packets in conjunction with Webinars. Baseline attitudes toward evidence-based practices and pressures for change appeared to mediate this effect. PMID:24091611

  18. Next-generation phenotyping of electronic health records

    PubMed Central

    Hripcsak, George; Albers, David J

    2013-01-01

    The national adoption of electronic health records (EHR) promises to make an unprecedented amount of data available for clinical research, but the data are complex, inaccurate, and frequently missing, and the record reflects complex processes aside from the patient's physiological state. We believe that the path forward requires studying the EHR as an object of interest in itself, and that new models, learning from data, and collaboration will lead to efficient use of the valuable information currently locked in health records. PMID:22955496

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

    MedlinePlus

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

  20. The use of electronic health records in Spanish hospitals.

    PubMed

    Marca, Guillem; Perez, Angel; Blanco-Garcia, Martin German; Miravalles, Elena; Soley, Pere; Ortiga, Berta

    2014-01-01

    The aims of this study were to describe the level of adoption of electronic health records in Spanish hospitals and to identify potential barriers and facilitators to this process. We used an observational cross-sectional design. The survey was conducted between September and December 2011, using an electronic questionnaire distributed through email. We obtained a 30% response rate from the 214 hospitals contacted, all belonging to the Spanish National Health Service. The level of adoption of electronic health records in Spanish hospitals was found to be high: 39.1% of hospitals surveyed had a comprehensive EHR system while a basic system was functioning in 32.8% of the cases. However, in 2011 one third of the hospitals did not have a basic electronic health record system, although some have since implemented electronic functionalities, particularly those related to clinical documentation and patient administration. Respondents cited the acquisition and implementation costs as the main barriers to implementation. Facilitators for EHR implementation were: the possibility to hire technical support, both during and post implementation; security certification warranty; and objective third-party evaluations of EHR products. In conclusion, the number of hospitals that have electronic health records is in general high, being relatively higher in medium-sized hospitals.

  1. Faculty and organizational characteristics associated with informatics/health information technology adoption in DNP programs.

    PubMed

    Fulton, Cathy R; Meek, Julie A; Walker, Patricia Hinton

    2014-01-01

    Nursing informatics/health information technology are key components of graduate nursing education and an accreditation requirement, yet little is known about the extent to which doctor of nursing practice (DNP) curricula include these content domains. The purpose of this descriptive study was to elicit perceptions of DNP program directors relative to (a) whether and how the American Association of Colleges of Nursing's (AACN's) Essential IV standard has been met in their DNP programs; (b) whether the Technology Informatics Guiding Educational Reform Initiative Foundation's Phase II competencies have been integrated in their programs; and (c) the faculty and organizational characteristics associated with the adoption of the AACN's Essential IV. In 2011, an electronic survey was sent to all 138 DNP program directors identified on the AACN Web site with an 81.2% response rate. Findings include variation in whether and how programs have integrated informatics/health information technology content, a lack of informatics-certified and/or master's-prepared faculty, and a perceived lack of faculty awareness of informatics curricular guidelines. DNP program director and dean awareness and support of faculty informatics education, use of informatics competency guidelines, and national policy and stimulus funding support are recommended to promote curricular inclusion and the engagement of nurses in strong informatics practices.

  2. The Adoption of Electronic Medical Records and Decision Support Systems in Korea

    PubMed Central

    Yoo, Ki Bong; Kim, Eun Sook; Chae, Hogene

    2011-01-01

    Objectives To examine the current status of hospital information systems (HIS), analyze the effects of Electronic Medical Records (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. PMID:22084812

  3. The Adoption and Use of Health Information Technology in Rural Areas: Results of a National Survey

    ERIC Educational Resources Information Center

    Singh, Ranjit; Lichter, Michael I.; Danzo, Andrew; Taylor, John; Rosenthal, Thomas

    2012-01-01

    Context: Health information technology (HIT) is a national policy priority. Knowledge about the special needs, if any, of rural health care providers should be taken into account as policy is put into action. Little is known, however, about rural-urban differences in HIT adoption at the national level. Purpose: To conduct the first national…

  4. Characteristics of community health organizations and decision-makers considering the adoption of motivational interviewing.

    PubMed

    Williams, Jessica Roberts; Dusablon, Tracy; Williams, Weston O; Blais, Marissa Puckett; Hennessy, Kevin D

    2014-07-01

    Research related to the adoption of comparative effectiveness research (CER) in mental health practice is limited. This study explores the factors that influence decisions to adopt motivational interviewing (MI)-an evidence-based practice (EBP) grounded in CER-among decision-makers (n = 311) in community health organizations (n = 92). Descriptive analyses focus on organization and decision-maker characteristics and processes that may influence the decision to adopt an EBP, including demographics, structure and operations, readiness, attitudes, barriers, and facilitators. Within-group agreement is examined to determine the degree to which participants within each organization gave similar responses. Results show characteristics differed according to type of organization (community health versus community behavioral health) and position (directors versus staff). Within-group agreement was also influenced by position. These findings indicate different strategies may be needed to best disseminate CER to the two groups.

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

    PubMed

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

    2010-02-01

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

  6. Strategies towards a compact XUV free electron laser adopted for the LUNEX5 project

    NASA Astrophysics Data System (ADS)

    Couprie, M. E.; Labat, M.; Evain, C.; Szwaj, C.; Bielawski, S.; Hubert, N.; Benabderrahmane, C.; Briquez, F.; Chapuis, L.; Marteau, F.; Valléau, M.; Marcouillé, O.; Marchand, P.; Diop, M.; Marlats, J. L.; Tavakoli, K.; Zerbib, D.; Cassinari, L.; Bouvet, F.; Herbeaux, C.; Bourassin-Bouchet, C.; Dennetière, D.; Polack, F.; Lestrade, A.; Khojoyan, M.; Yang, W.; Sharma, G.; Morin, P.; Loulergue, A.

    2016-02-01

    More than 50 years after the laser discovery, X-ray free electron lasers (FEL), the first powerful tuneable, short pulse lasers in the X-ray spectral range, are now blooming in the world, enabling new discoveries on the ultra-fast dynamics of excited systems and imaging. LUNEX5 demonstrator project aims at investigating paths towards advanced and compact FELs. Two strategies are adopted. The first one concerns the FEL line where seeding and echo harmonic generation are implemented together with compact cryogenic in-vacuum undulators. In the second one, the electron beam is no longer provided by a conventional linear accelerator but by a laser plasma process, while a necessary particular electron beam manipulation is required to handle the electron properties to enable FEL amplification.

  7. Electronic Health Records and the Evolution of Diabetes Care

    PubMed Central

    Patel, Vishal; Reed, Mary E.; Grant, Richard W.

    2015-01-01

    Adoption of electronic health records (EHRs) has increased dramatically since the 2009 implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The latest data from the Centers for Disease Control and Prevention (CDC) indicate that the majority of U.S. hospitals and nearly half of U.S. health care professionals have implemented an EHR with advanced functionality.1 The goals of the HITECH act were not only to incentivize the adoption of EHRs, but also to increase the quality, safety, and efficiency of health care by promoting the concept of “meaningful use.”2,3 The stepwise implementation of “meaningful use” is now entering the latter stages with a focus on improving patient outcomes.4 PMID:25711684

  8. Electronic Health Records and Quality of Care

    PubMed Central

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

    2016-01-01

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

  9. Applying Observations from Technological Transformations in Complex Adaptive Systems to Inform Health Policy on Technology Adoption

    PubMed Central

    Phillips, Andrew B.; Merrill, Jacqueline

    2012-01-01

    Many complex markets such as banking and manufacturing have benefited significantly from technology adoption. Each of these complex markets experienced increased efficiency, quality, security, and customer involvement as a result of technology transformation in their industry. Healthcare has not benefited to the same extent. We provide initial findings from a policy analysis of complex markets and the features of these transformations that can influence health technology adoption and acceptance. PMID:24199112

  10. Applying observations from technological transformations in complex adaptive systems to inform health policy on technology adoption.

    PubMed

    Phillips, Andrew B; Merrill, Jacqueline

    2012-01-01

    Many complex markets such as banking and manufacturing have benefited significantly from technology adoption. Each of these complex markets experienced increased efficiency, quality, security, and customer involvement as a result of technology transformation in their industry. Healthcare has not benefited to the same extent. We provide initial findings from a policy analysis of complex markets and the features of these transformations that can influence health technology adoption and acceptance. PMID:24199112

  11. Adoption of Evidence-Based Interventions in Local Health Departments: "1-2-3 Pap NC".

    PubMed

    Winterbauer, Nancy L; Bridger, Colleen M; Tucker, Ashley; Rafferty, Ann P; Luo, Huabin

    2015-08-01

    Descriptions of barriers and facilitators to adoption of evidence-based interventions in local health departments (LHDs) are limited. This study was conducted by the North Carolina Public Health Practice-Based Research Network to identify factors associated with adoption of an evidence-based human papillomavirus video intervention, "1-2-3 Pap NC," in North Carolina LHDs. A sequential mixed-method study design was used. Data from the 2013 National Profile of Local Health Departments were used to test associations between LHD characteristics and adoption of the intervention. Qualitative, key stakeholder interviews with LHD directors provided the context for quantitative data. Data collection and analysis continued from March 3, 2014, to September 15, 2014. Overall, 28% of North Carolina health jurisdictions (33 of 100 counties) implemented the intervention. Of the three channels used to deliver the intervention to clients, most LHDs opted to show the video in the exam room (42%), followed by website/other social media (36%) and video loop in the lobby/waiting room (22%). In logistic regression, gender of the director (female) was significantly and positively associated with adoption of the intervention (AOR=4.44, p<0.05). Being a first-time director was marginally significant (AOR=0.28, p=0.074), suggesting first-time directors were less likely to adopt. Qualitative results suggested that aspects of communication (awareness and positive attitudes) and agency directors' evaluation of resources, balanced against intervention complexity and flexibility, competing priorities, and mandates, influenced adoption. Adoption of evidence-based interventions by LHDs is critical to improve population health. Practice-based research can contribute to understanding facilitators and modifying barriers to this process. PMID:26190805

  12. Adoption of Evidence-Based Interventions in Local Health Departments: "1-2-3 Pap NC".

    PubMed

    Winterbauer, Nancy L; Bridger, Colleen M; Tucker, Ashley; Rafferty, Ann P; Luo, Huabin

    2015-08-01

    Descriptions of barriers and facilitators to adoption of evidence-based interventions in local health departments (LHDs) are limited. This study was conducted by the North Carolina Public Health Practice-Based Research Network to identify factors associated with adoption of an evidence-based human papillomavirus video intervention, "1-2-3 Pap NC," in North Carolina LHDs. A sequential mixed-method study design was used. Data from the 2013 National Profile of Local Health Departments were used to test associations between LHD characteristics and adoption of the intervention. Qualitative, key stakeholder interviews with LHD directors provided the context for quantitative data. Data collection and analysis continued from March 3, 2014, to September 15, 2014. Overall, 28% of North Carolina health jurisdictions (33 of 100 counties) implemented the intervention. Of the three channels used to deliver the intervention to clients, most LHDs opted to show the video in the exam room (42%), followed by website/other social media (36%) and video loop in the lobby/waiting room (22%). In logistic regression, gender of the director (female) was significantly and positively associated with adoption of the intervention (AOR=4.44, p<0.05). Being a first-time director was marginally significant (AOR=0.28, p=0.074), suggesting first-time directors were less likely to adopt. Qualitative results suggested that aspects of communication (awareness and positive attitudes) and agency directors' evaluation of resources, balanced against intervention complexity and flexibility, competing priorities, and mandates, influenced adoption. Adoption of evidence-based interventions by LHDs is critical to improve population health. Practice-based research can contribute to understanding facilitators and modifying barriers to this process.

  13. Survey of electronic veterinary medical record adoption and use by independent small animal veterinary medical practices in Massachusetts

    PubMed Central

    Krone, Lauren M.; Brown, Catherine M.; Lindenmayer, Joann M.

    2016-01-01

    Objective To estimate the proportion of independent small animal veterinary medical practices in Massachusetts that use electronic veterinary medical records (EVMRs), determine the purposes for which EVMRs are used, and identify perceived barriers to their use. Design Survey. Sample 100 veterinarians. Procedures 213 of 517 independent small animal veterinary practices operating in Massachusetts were randomly chosen for study recruitment. One veterinarian at each practice was invited by telephone to answer a hardcopy survey regarding practice demographics, medical records type (electronic, paper, or both), purposes of EVMR use, and perceived barriers to adoption. Surveys were mailed to the first 100 veterinarians who agreed to participate. Practices were categorized by record type and size (large [≥ 5 veterinarians], medium [3 to 4 veterinarians], or small [1 to 2 veterinarians]). Results 84 surveys were returned; overall response was 84 of 213 (39.4%). The EVMRs were used alone or together with paper records in 66 of 82 (80.5%) practices. Large and medium-sized practices were significantly more likely to use EVMRs combined with paper records than were small practices. The EVMRs were most commonly used for ensuring billing, automating reminders, providing cost estimates, scheduling, recording medical and surgical information, and tracking patient health. Least common uses were identifying emerging infectious diseases, research, and insurance. Eleven veterinarians in paper record–only practices indicated reluctance to change, anticipated technological problems, time constraints, and cost were barriers to EVMR use. Conclusions and Clinical Relevance Results indicated EVMRs were underutilized as a tool for tracking and improving population health and identifying emerging infectious diseases. Efforts to facilitate adoption of EVMRs for these purposes should be strengthened by the veterinary medical, human health, and public health professions. PMID:25029312

  14. Baby Boomers’ Adoption of Consumer Health Technologies: Survey on Readiness and Barriers

    PubMed Central

    2014-01-01

    Background As they age, baby boomers (born 1946-1964) will have increasing medical needs and are likely to place large demand on health care resources. Consumer health technologies may help stem rising health care needs and costs by improving provider-to-patient communication, health monitoring, and information access and enabling self-care. Research has not explored the degree to which baby boomers are ready for, or are currently embracing, specific consumer health technologies This study explores how baby boomers’ readiness to use various technologies for health purposes compares to other segments of the adult population. Objective The goals of the study are to (1) examine what technologies baby boomers are ready to use for health purposes, (2) investigate barriers to baby boomers’ use of technology for health purposes, and (3) understand whether readiness for and barriers to baby boomers’ use of consumer health technologies differ from those of other younger and older consumers. Methods Data were collected via a survey offered to a random sample of 3000 subscribers to a large pharmacy benefit management company. Respondents had the option to complete the survey online or by completing a paper-based version of the survey. Results Data from 469 respondents (response rate 15.63%) were analyzed, including 258 baby boomers (aged 46-64 years), 72 younger (aged 18-45 years), and 139 older (age >64 years) participants. Baby boomers were found to be similar to the younger age group, but significantly more likely than the older age group to be ready to use 5 technologies for health purposes (health information websites, email, automated call centers, medical video conferencing, and texting). Baby boomers were less ready than the younger age group to adopt podcasts, kiosks, smartphones, blogs, and wikis for health care purposes. However, baby boomers were more likely than older adults to use smartphones and podcasts for health care purposes. Specific adoption

  15. The Adoption of Mental Health Drugs on State AIDS Drug Assistance Program Formularies

    PubMed Central

    Barry, Colleen L.

    2011-01-01

    Objectives. We sought state-level factors associated with the adoption of medications to treat mental health conditions on state formularies for the AIDS Drug Assistance Program. Methods. We interviewed 22 state and national program experts and identified 7 state-level factors: case burden, federal dollar-per-case Ryan White allocation size, political orientation, state wealth, passage of a mental health parity law, number of psychiatrists per population, and size of mental health budget. We then used survival analysis to test whether the factors were associated with faster adoption of psychotropic drugs from 1997 to 2008. Results. The relative size of a state's federal Ryan White HIV/AIDS Program allocation, the state's political orientation, and its concentration of psychiatrists were significantly associated with time-to-adoption of psychotropic drugs on state AIDS Drug Assistance Program formularies. Conclusions. Substantial heterogeneity exists across states in formulary adoption of drugs to treat mental illness. Understanding what factors contribute to variation in adoption is vital given the importance of treating mental health conditions as a component of comprehensive HIV care. PMID:21493949

  16. PACS and electronic health records

    NASA Astrophysics Data System (ADS)

    Cohen, Simona; Gilboa, Flora; Shani, Uri

    2002-05-01

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

  17. Adopting the primary health care approach in malaria control in Malaysia: lessons in community participation.

    PubMed

    Riji, H M

    1992-01-01

    The Primary Health Care approach in Malaysia was first tried out in Sarawak, East Malaysia in 1982. In 1984, the Vector Borne Disease Control Program, Kelantan decided to adopt the Primary Health Care approach as an additional strategy in its effort to control malaria in the state, which then experienced an increase in malaria cases. Much effort was directed at creating the awareness and stimulating the interest of health staff and communities to adopt the strategy. Kelantan was made the model state. The paper gives an outline of the process involved and some characteristics of PHC workers. A study was carried out among health workers, community members and health staff on their knowledge and involvement in PHC in three states, including Kelantan. In view of the overall success of this approach, and the weaknesses which have been identified possible solutions have been suggested and should be acted upon.

  18. A cloud based architecture to support Electronic Health Record.

    PubMed

    Zangara, Gianluca; Corso, Pietro Paolo; Cangemi, Francesco; Millonzi, Filippo; Collova, Francesco; Scarlatella, Antonio

    2014-01-01

    We introduce a novel framework of electronic healthcare enabled by a Cloud platform able to host both Hospital Information Systems (HIS) and Electronic Medical Record (EMR) systems and implement an innovative model of Electronic Health Record (EHR) that is not only patient-oriented but also supports a better governance of the whole healthcare system. The proposed EHR model adopts the state of the art of the Cloud technologies, being able to join the different clinical data of the patient stored within the HISs and EMRs either placed into a local Data Center or hosted into a Cloud Platform enabling new directions of data analysis. PMID:25488244

  19. HIPAA update: standards for health care electronic transactions finalized.

    PubMed

    McMahon, E B

    2000-10-01

    The Department for Health and Human Services (HHS) has issued the final rule that will govern electronic exchanges of financial and administrative information in the health care industry. About 400 different formats currently exist for electronic health care claims. Once compliance with this rule is required (October 2002 for most health care entities to which the rule applies), a physician will be able to submit an electronic claim in the standard transaction format to virtually any health plan in the United States and the health plan will have to accept it. Under the rule, an electronic transaction involves information exchanges between two parties to carry out financial or administrative activities related to health care. Thus, health plans will be able to pay physicians, authorize services, certify referrals, and coordinate benefits using a standard electronic format for each transaction. Conflicting state laws will be superseded by the standards, although HHS is developing an exception process pursuant to HIPAA. HIPAA required HHS to adopt data and format standards, if possible, that were developed by private sector standards development organizations accredited by the American National Standards Institute (ANSI). When conducting a transaction covered by the rule, physicians are required to use applicable medical data code sets as specified in the implementation specification that is valid at the time the health care is furnished. Local and proprietary codes currently used by health plans can no longer be used in electronic transactions governed by the rule after the compliance date (October 16, 2002, except for small health plans, which have until October 16, 2003). This summary of the Standards for Electronic Transactions should not be construed as legal advice or an opinion on specific situations. Please consult an attorney concerning your compliance with HIPAA and the regulations promulgated thereunder. PMID:16906180

  20. Electronic Health Records: Permanent, Private, and Informative | NIH MedlinePlus the Magazine

    MedlinePlus

    ... benefits, and some of the issues regarding their adoption. Fast Facts What Is the Difference Between a ... Office of the National Coordinator for Health Information Technology ( http://healthit.hhs.gov/ ) What is an electronic ...

  1. Relationship between age at gonadectomy and health problems in kittens adopted from shelters.

    PubMed

    Porters, N; Polis, I; Moons, C P H; Van de Maele, I; Ducatelle, R; Goethals, K; Duchateau, L; de Rooster, H

    2015-05-30

    Prepubertal gonadectomy (PPG) is promoted as a way of managing overpopulation in cats, but concerns about PPG and potential health issues still exist. The objective of the present study was to evaluate short-term and long-term health problems in cats subjected to PPG in comparison to gonadectomy at traditional age (TAG). In a prospective clinical trial, 800 shelter kittens aged between approximately 8 weeks and 12 weeks were recruited before adoption and randomly assigned to either the PPG group (gonadectomy performed immediately) or the TAG group (gonadectomy delayed until six months to eight months of age). Short-term health issues included mortality between when kittens arrived at the clinic and up to seven days after they returned to the shelter, as well as the occurrence of various other health issues arising in the first month following adoption. Kittens were followed-up until 24 months of age specifically for feline lower urinary tract disease, urethral obstruction (male cats), lameness, fractures and hypersensitivity disorders with dermatological presentation. In the short term, there were no significant differences between health problems in PPG and TAG kittens. Similarly, no significant differences were observed between treatment groups in terms of the type or number of health issues in the long term. In conclusion, there are no health-related contraindications to advocating PPG strategies in shelter cats. Ideally, PPG should be performed at the shelter facility itself as long as excellent infectious disease control and postoperative clinical observation before adoption are guaranteed. PMID:25820324

  2. Developmental Surveillance and Screening in the Electronic Health Record.

    PubMed

    Smith, Timothy Ryan

    2016-10-01

    Effective well-child care includes developmental surveillance and screening to identify developmental delays and subsequent interventions. Electronic health records (EHRs) have been widely adopted to improve efficiency and appropriate clinical practice. Developmental surveillance tools have been introduced. This article summarizes a conceptual framework for application and highlights the principles and tools of EHRs applied to developmental assessment, including interoperability, health information exchange, clinical decision support systems, consumer health informatics, dashboards, and patient portals. Further investigation and dedicated resources will be required for successful application to developmental surveillance and screening.

  3. Developmental Surveillance and Screening in the Electronic Health Record.

    PubMed

    Smith, Timothy Ryan

    2016-10-01

    Effective well-child care includes developmental surveillance and screening to identify developmental delays and subsequent interventions. Electronic health records (EHRs) have been widely adopted to improve efficiency and appropriate clinical practice. Developmental surveillance tools have been introduced. This article summarizes a conceptual framework for application and highlights the principles and tools of EHRs applied to developmental assessment, including interoperability, health information exchange, clinical decision support systems, consumer health informatics, dashboards, and patient portals. Further investigation and dedicated resources will be required for successful application to developmental surveillance and screening. PMID:27565369

  4. Integrating an Academic Electronic Health Record: Challenges and Success Strategies.

    PubMed

    Herbert, Valerie M; Connors, Helen

    2016-08-01

    Technology is increasing the complexity in the role of today's nurse. Healthcare organizations are integrating more health information technologies and relying on the electronic health record for data collection, communication, and decision making. Nursing faculty need to prepare graduates for this environment and incorporate an academic electronic health record into a nursing curriculum to meet student-program outcomes. Although the need exists for student preparation, some nursing programs are struggling with implementation, whereas others have been successful. To better understand these complexities, this project was intended to identify current challenges and success strategies of effective academic electronic health record integration into nursing curricula. Using Rogers' 1962 Diffusion of Innovation theory as a framework for technology adoption, a descriptive survey design was used to gain insights from deans and program directors of nursing schools involved with the national Health Informatics & Technology Scholars faculty development program or Cerner's Academic Education Solution Consortium, working to integrate an academic electronic health record in their respective nursing schools. The participants' experiences highlighted approaches used by these schools to integrate these technologies. Data from this project provide nursing education with effective strategies and potential challenges that should be addressed for successful academic electronic health record integration.

  5. Integrating an Academic Electronic Health Record: Challenges and Success Strategies.

    PubMed

    Herbert, Valerie M; Connors, Helen

    2016-08-01

    Technology is increasing the complexity in the role of today's nurse. Healthcare organizations are integrating more health information technologies and relying on the electronic health record for data collection, communication, and decision making. Nursing faculty need to prepare graduates for this environment and incorporate an academic electronic health record into a nursing curriculum to meet student-program outcomes. Although the need exists for student preparation, some nursing programs are struggling with implementation, whereas others have been successful. To better understand these complexities, this project was intended to identify current challenges and success strategies of effective academic electronic health record integration into nursing curricula. Using Rogers' 1962 Diffusion of Innovation theory as a framework for technology adoption, a descriptive survey design was used to gain insights from deans and program directors of nursing schools involved with the national Health Informatics & Technology Scholars faculty development program or Cerner's Academic Education Solution Consortium, working to integrate an academic electronic health record in their respective nursing schools. The participants' experiences highlighted approaches used by these schools to integrate these technologies. Data from this project provide nursing education with effective strategies and potential challenges that should be addressed for successful academic electronic health record integration. PMID:27326804

  6. ICT health 2013: infrastructure and adoption by healthcare providers in Brazil.

    PubMed

    Marin, Heimar F; Senne, Fabio; Barbosa, Alexandre

    2014-01-01

    The potential offered by intensive and strategic adoption of information and communication technologies for obtaining advances in the health sector is worldwide recognized. In order to monitor the implementation of ICT in health policies in Brazil and to establish internationally comparable indicators, a nationwide survey was conducted to identify the current implementation of information and communication technologies in Healthcare facilities and its adoption by providers. Data collection was carried out from February to August 2013 using two structured questionnaires. The results obtained showed that the access to internet is nearly universal in the country but clinical information systems are still in its infancy when it comes to more complex functionalities and linked to clinical decision support. Healthcare professionals indicated that the main barrier to adopt is the lack of availability related to the patient information.

  7. Health insurance reform: modifications to the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards. Proposed rule.

    PubMed

    2008-08-22

    This rule proposes to adopt updated versions of the standards for electronic transactions originally adopted in the regulations entitled, "Health Insurance Reform: Standards for Electronic Transactions," published in the Federal Register on August 17, 2000, which implemented some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These standards were modified in our rule entitled, "Health Insurance Reform: Modifications to Electronic Data Transaction Standards and Code Sets," published in the Federal Register on February 20, 2003. This rule also proposes the adoption of a transaction standard for Medicaid Pharmacy Subrogation. In addition, this rule proposes to adopt two standards for billing retail pharmacy supplies and professional services, and to clarify who the "senders" and "receivers" are in the descriptions of certain transactions. PMID:18958949

  8. Impact of Electronic Health Records on Nurses' Information Seeking and Discriminating Skills for Critical Thinking

    ERIC Educational Resources Information Center

    Jackson, Adria S.

    2013-01-01

    In February 2009, the United States government passed into law the Health Information Technology for Economic and Clinical Health Act (HITECH) and the American Recovery and Reinvestment Act (ARRA) providing incentive money for hospitals and care providers to implement a certified electronic health record (EHR) in order to promote the adoption and…

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

    ERIC Educational Resources Information Center

    Tannan, Ritu

    2012-01-01

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

  10. Missed Policy Opportunities to Advance Health Equity by Recording Demographic Data in Electronic Health Records

    PubMed Central

    Dawes, Daniel E.; Holden, Kisha B.; Mack, Dominic

    2015-01-01

    The science of eliminating health disparities is complex and dependent on demographic data. The Health Information Technology for Economic and Clinical Health Act (HITECH) encourages the adoption of electronic health records and requires basic demographic data collection; however, current data generated are insufficient to address known health disparities in vulnerable populations, including individuals from diverse racial and ethnic backgrounds, with disabilities, and with diverse sexual identities. We conducted an administrative history of HITECH and identified gaps between the policy objective and required measure. We identified 20 opportunities for change and 5 changes, 2 of which required the collection of less data. Until health care demographic data collection requirements are consistent with public health requirements, the national goal of eliminating health disparities cannot be realized. PMID:25905840

  11. Radio frequency identification (RFID) in health care: privacy and security concerns limiting adoption.

    PubMed

    Rosenbaum, Benjamin P

    2014-03-01

    Radio frequency identification (RFID) technology has been implemented in a wide variety of industries. Health care is no exception. This article explores implementations and limitations of RFID in several health care domains: authentication, medication safety, patient tracking, and blood transfusion medicine. Each domain has seen increasing utilization of unique applications of RFID technology. Given the importance of protecting patient and data privacy, potential privacy and security concerns in each domain are discussed. Such concerns, some of which are inherent to existing RFID hardware and software technology, may limit ubiquitous adoption. In addition, an apparent lack of security standards within the RFID domain and specifically health care may also hinder the growth and utility of RFID within health care for the foreseeable future. Safeguarding the privacy of patient data may be the most important obstacle to overcome to allow the health care industry to take advantage of the numerous benefits RFID technology affords.

  12. Personal Health Record Use in the United States: Forecasting Future Adoption Levels

    PubMed Central

    Huerta, Timothy R

    2016-01-01

    Background Personal health records (PHRs) offer a tremendous opportunity to generate consumer support in pursing the triple aim of reducing costs, increasing access, and improving care quality. Moreover, surveys in the United States indicate that consumers want Web-based access to their medical records. However, concerns that consumers’ low health information literacy levels and physicians’ resistance to sharing notes will limit PHRs’ utility to a relatively small portion of the population have reduced both the product innovation and policy imperatives. Objective The purpose of our study was 3-fold: first, to report on US consumers’ current level of PHR activity; second, to describe the roles of imitation and innovation influence factors in determining PHR adoption rates; and third, to forecast future PHR diffusion uptake among US consumers under 3 scenarios. Methods We used secondary data from the Health Information National Trends Survey (HINTS) of US citizens for the survey years 2008, 2011, and 2013. Applying technology diffusion theory and Bass modeling, we evaluated 3 future PHR adoption scenarios by varying the introduction dates. Results All models displayed the characteristic diffusion S-curve indicating that the PHR technology is likely to achieve significant market penetration ahead of meaningful use goals. The best-performing model indicates that PHR adoption will exceed 75% by 2020. Therefore, the meaningful use program targets for PHR adoption are below the rates likely to occur without an intervention. Conclusions The promise of improved care quality and cost savings through better consumer engagement prompted the US Institute of Medicine to call for universal PHR adoption in 1999. The PHR products available as of 2014 are likely to meet and exceed meaningful use stage 3 targets before 2020 without any incentive. Therefore, more ambitious uptake and functionality availability should be incorporated into future goals. PMID:27030105

  13. Health effects of adopting low greenhouse gas emission diets in the UK

    PubMed Central

    Milner, James; Green, Rosemary; Dangour, Alan D; Haines, Andy; Chalabi, Zaid; Spadaro, Joseph; Markandya, Anil; Wilkinson, Paul

    2015-01-01

    Objective Dietary changes which improve health are also likely to be beneficial for the environment by reducing emissions of greenhouse gases (GHG). However, previous analyses have not accounted for the potential acceptability of low GHG diets to the general public. This study attempted to quantify the health effects associated with adopting low GHG emission diets in the UK. Design Epidemiological modelling study. Setting UK. Participants UK population. Intervention Adoption of diets optimised to achieve the WHO nutritional recommendations and reduce GHG emissions while remaining as close as possible to existing dietary patterns. Main outcome Changes in years of life lost due to coronary heart disease, stroke, several cancers and type II diabetes, quantified using life tables. Results If the average UK dietary intake were optimised to comply with the WHO recommendations, we estimate an incidental reduction of 17% in GHG emissions. Such a dietary pattern would be broadly similar to the current UK average. Our model suggests that it would save almost 7 million years of life lost prematurely in the UK over the next 30 years and increase average life expectancy by over 8 months. Diets that result in additional GHG emission reductions could achieve further net health benefits. For emission reductions greater than 40%, improvements in some health outcomes may decrease and acceptability will diminish. Conclusions There are large potential benefits to health from adopting diets with lower associated GHG emissions in the UK. Most of these benefits can be achieved without drastic changes to existing dietary patterns. However, to reduce emissions by more than 40%, major dietary changes that limit both acceptability and the benefits to health are required. PMID:25929258

  14. Health Status, Cognitive and Motor Development of Young Children Adopted from China, East Asia, and Russia across the First 6 Months after Adoption

    ERIC Educational Resources Information Center

    Pomerleau, Andree; Malcuit, Gerard; Chicoine, Jean-Francois; Seguin, Renee; Belhumeur, Celine; Germain, Patricia; Amyot, Isabelle; Jeliu, Gloria

    2005-01-01

    We compared health status, anthropometric and psychological development of 123 children adopted before 18 months of age from China, East Asia (Vietnam, Taiwan, Thailand, South Korea, Cambodia), and Eastern Europe (mostly Russia). Data were collected close to the time of arrival, and 3 and 6 months later. Anthropometric measures included weight,…

  15. Health, agricultural, and economic effects of adoption of healthy diet recommendations.

    PubMed

    Lock, Karen; Smith, Richard D; Dangour, Alan D; Keogh-Brown, Marcus; Pigatto, Gessuir; Hawkes, Corinna; Fisberg, Regina Mara; Chalabi, Zaid

    2010-11-13

    Transition to diets that are high in saturated fat and sugar has caused a global public health concern, as the pattern of food consumption is a major modifiable risk factor for chronic non-communicable diseases. Although agri-food systems are intimately associated with this transition, agriculture and health sectors are largely disconnected in their priorities, policy, and analysis, with neither side considering the complex inter-relation between agri-trade, patterns of food consumption, health, and development. We show the importance of connection of these perspectives through estimation of the eff ect of adopting a healthy diet on population health, agricultural production, trade, the economy, and livelihoods,with a computable general equilibrium approach. On the basis of case-studies from the UK and Brazil, we suggest that benefits of a healthy diet policy will vary substantially between different populations, not only because of population dietary intake but also because of agricultural production, trade, and other economic factors.

  16. Adopting Clean Fuels and Technologies on School Buses. Pollution and Health Impacts in Children

    PubMed Central

    D’Souza, Jennifer; Sheppard, Lianne; Kaufman, Joel D.; Hallstrand, Teal S.; Davey, Mark E.; Sullivan, James R.; Jahnke, Jordan; Koenig, Jane; Larson, Timothy V.; Liu, L. J. Sally

    2015-01-01

    Rationale: More than 25 million American children breathe polluted air on diesel school buses. Emission reduction policies exist, but the health impacts to individual children have not been evaluated. Methods: Using a natural experiment, we characterized the exposures and health of 275 school bus riders before, during, and after the adoption of clean technologies and fuels between 2005 and 2009. Air pollution was measured during 597 trips on 188 school buses. Repeated measures of exhaled nitric oxide (FeNO), lung function (FEV1, FVC), and absenteeism were also collected monthly (1,768 visits). Mixed-effects models longitudinally related the adoption of diesel oxidation catalysts (DOCs), closed crankcase ventilation systems (CCVs), ultralow-sulfur diesel (ULSD), or biodiesel with exposures and health. Measurements and Main Results: Fine and ultrafine particle concentrations were 10–50% lower on buses using ULSD, DOCs, and/or CCVs. ULSD adoption was also associated with reduced FeNO (−16% [95% confidence interval (CI), −21 to −10%]), greater changes in FVC and FEV1 (0.02 [95% CI, 0.003 to 0.05] and 0.01 [95% CI, −0.006 to 0.03] L/yr, respectively), and lower absenteeism (−8% [95% CI, −16.0 to −0.7%]), with stronger associations among patients with asthma. DOCs, and to a lesser extent CCVs, also were associated with improved FeNO, FVC growth, and absenteeism, but these findings were primarily restricted to patients with persistent asthma and were often sensitive to control for ULSD. No health benefits were noted for biodiesel. Extrapolating to the U.S. population, changed fuel/technologies likely reduced absenteeism by more than 14 million/yr. Conclusions: National and local diesel policies appear to have reduced children’s exposures and improved health. PMID:25867003

  17. Engaging Nurses in the Design and Adoption of mHealth Tools for Care Coordination.

    PubMed

    Murphy, Judy

    2016-01-01

    This panel will share ideas for the Nursing Informatics Specialists in the audience on how mHealth tools are being designed and used for clinical practice, education and research. They will describe specific mHealth projects they are involved in, give practical examples, and provide tangible tactics for nurses to make a difference. They will provide insight into new technology and standards developments that make it easy to connect the mobile app ecosystem - from open application program interfaces (APIs), to traditional health information technology tools like Electronic Health Records (EHRs). PMID:27332334

  18. Health insurance reform: modifications to electronic data transaction standards and code sets. Final rule.

    PubMed

    2003-02-20

    In this final rule, we respond to public comments received and finalize provisions applicable to electronic data transaction standards from two related proposed rules published in the May 31, 2002, Federal Register. We are also adopting proposed modifications to implementation specifications for health care entities and others. In addition, we are adopting modifications to implementation specifications for several electronic transaction standards that were omitted from the May 31, 2002, proposed rules. PMID:12596713

  19. Electronic Personal Health Record Use Among Nurses in the Nursing Informatics Community.

    PubMed

    Gartrell, Kyungsook; Trinkoff, Alison M; Storr, Carla L; Wilson, Marisa L

    2015-07-01

    An electronic personal health record is a patient-centric tool that enables patients to securely access, manage, and share their health information with healthcare providers. It is presumed the nursing informatics community would be early adopters of electronic personal health record, yet no studies have been identified that examine the personal adoption of electronic personal health record's for their own healthcare. For this study, we sampled nurse members of the American Medical Informatics Association and the Healthcare Information and Management Systems Society with 183 responding. Multiple logistic regression analysis was used to identify those factors associated with electronic personal health record use. Overall, 72% were electronic personal health record users. Users tended to be older (aged >50 years), be more highly educated (72% master's or doctoral degrees), and hold positions as clinical informatics specialists or chief nursing informatics officers. Those whose healthcare providers used electronic health records were significantly more likely to use electronic personal health records (odds ratio, 5.99; 95% confidence interval, 1.40-25.61). Electronic personal health record users were significantly less concerned about privacy of health information online than nonusers (odds ratio, 0.32; 95% confidence interval, 0.14-0.70) adjusted for ethnicity, race, and practice region. Informatics nurses, with their patient-centered view of technology, are in prime position to influence development of electronic personal health records. Our findings can inform policy efforts to encourage informatics and other professional nursing groups to become leaders and users of electronic personal health record; such use could help them endorse and engage patients to use electronic personal health records. Having champions with expertise in and enthusiasm for the new technology can promote the adoptionof electronic personal health records among healthcare providers as well as

  20. Electronic Personal Health Record Use Among Nurses in the Nursing Informatics Community.

    PubMed

    Gartrell, Kyungsook; Trinkoff, Alison M; Storr, Carla L; Wilson, Marisa L

    2015-07-01

    An electronic personal health record is a patient-centric tool that enables patients to securely access, manage, and share their health information with healthcare providers. It is presumed the nursing informatics community would be early adopters of electronic personal health record, yet no studies have been identified that examine the personal adoption of electronic personal health record's for their own healthcare. For this study, we sampled nurse members of the American Medical Informatics Association and the Healthcare Information and Management Systems Society with 183 responding. Multiple logistic regression analysis was used to identify those factors associated with electronic personal health record use. Overall, 72% were electronic personal health record users. Users tended to be older (aged >50 years), be more highly educated (72% master's or doctoral degrees), and hold positions as clinical informatics specialists or chief nursing informatics officers. Those whose healthcare providers used electronic health records were significantly more likely to use electronic personal health records (odds ratio, 5.99; 95% confidence interval, 1.40-25.61). Electronic personal health record users were significantly less concerned about privacy of health information online than nonusers (odds ratio, 0.32; 95% confidence interval, 0.14-0.70) adjusted for ethnicity, race, and practice region. Informatics nurses, with their patient-centered view of technology, are in prime position to influence development of electronic personal health records. Our findings can inform policy efforts to encourage informatics and other professional nursing groups to become leaders and users of electronic personal health record; such use could help them endorse and engage patients to use electronic personal health records. Having champions with expertise in and enthusiasm for the new technology can promote the adoptionof electronic personal health records among healthcare providers as well as

  1. Electronic Health Records and Community Health Surveillance of Childhood Obesity

    PubMed Central

    Flood, Tracy L.; Zhao, Ying-Qi; Tomayko, Emily J.; Tandias, Aman; Carrel, Aaron L.; Hanrahan, Lawrence P.

    2015-01-01

    Background Childhood obesity remains a public health concern, and tracking local progress may require local surveillance systems. Electronic health record data may provide a cost-effective solution. Purpose To demonstrate the feasibility of estimating childhood obesity rates using de-identified electronic health records for the purpose of public health surveillance and health promotion. Methods Data were extracted from the Public Health Information Exchange (PHINEX) database. PHINEX contains de-identified electronic health records from patients primarily in south central Wisconsin. Data on children and adolescents (aged 2–19 years, 2011–2012, n=93,130) were transformed in a two-step procedure that adjusted for missing data and weighted for a national population distribution. Weighted and adjusted obesity rates were compared to the 2011–2012 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in 2014. Results The weighted and adjusted obesity rate was 16.1% (95% CI=15.8, 16.4). Non-Hispanic white children and adolescents (11.8%, 95% CI=11.5, 12.1) had lower obesity rates compared to non-Hispanic black (22.0%, 95% CI=20.7, 23.2) and Hispanic (23.8%, 95% CI=22.4, 25.1) patients. Overall, electronic health record–derived point estimates were comparable to NHANES, revealing disparities from preschool onward. Conclusions Electronic health records that are weighted and adjusted to account for intrinsic bias may create an opportunity for comparing regional disparities with precision. In PHINEX patients, childhood obesity disparities were measurable from a young age, highlighting the need for early intervention for at-risk children. The electronic health record is a cost-effective, promising tool for local obesity prevention efforts. PMID:25599907

  2. HealthPartners adopts community business model to deepen focus on nonclinical factors of health outcomes.

    PubMed

    Isham, George J; Zimmerman, Donna J; Kindig, David A; Hornseth, Gary W

    2013-08-01

    Clinical care contributes only 20 percent to overall health outcomes, according to a population health model developed at the University of Wisconsin. Factors contributing to the remainder include lifestyle behaviors, the physical environment, and social and economic forces--all generally considered outside the realm of care. In 2010 Minnesota-based HealthPartners decided to target nonclinical community health factors as a formal part of its strategic business plan to improve public health in the Twin Cities area. The strategy included creating partnerships with businesses and institutions that are generally unaccustomed to working together or considering how their actions could help improve community health. This article describes efforts to promote healthy eating in schools, reduce the stigma of mental illness, improve end-of-life decision making, and strengthen an inner-city neighborhood. Although still in their early stages, the partnerships can serve as encouragement for organizations inside and outside health care that are considering undertaking similar efforts in their markets.

  3. Information and communications technology in U.S. health care: why is adoption so slow and is slower better?

    PubMed

    Christensen, Michael C; Remler, Dahlia

    2009-12-01

    Politicians across the political spectrum support greater investment in health care information and communications technology (ICT) and expect it to significantly decrease costs and improve health outcomes. We address three policy questions about adoption of ICT in health care: First, why is there so little adoption? Second, what policies will facilitate and accelerate adoption? Third, what is the best pace for adoption? We first describe the unusual economics of ICT, particularly network externalities, and then determine how those economics interact with and are exacerbated by the unusual economics of health care. High replacement costs and the need for technical compatibility are general barriers to ICT adoption and often result in lock-in to adopted technologies. These effects are compounded in health care because the markets for health care services, health insurance, and labor are interlinked. In addition, the government interacts with all markets in its role as an insurer. Patient heterogeneity further exacerbates these effects. Finally, ICT markets are often characterized by natural monopolies, resulting in little product diversity, an effect ill-suited to patient heterogeneity. The ongoing process for setting technical standards for health care ICT is critical but needs to include all relevant stakeholders, including patient groups. The process must be careful (i.e., slow), flexible, and allow for as much diversity as possible. We find that waiting to adopt ICT is a surprisingly wise policy.

  4. Partners in Health: A Conceptual Framework for the Role of Community Health Workers in Facilitating Patients' Adoption of Healthy Behaviors

    PubMed Central

    Van Devanter, Nancy; Islam, Nadia; Trinh-Shevrin, Chau

    2015-01-01

    We formulated a conceptual framework that begins to answer the national call to improve health care access, delivery, and quality by explaining the processes through which community health workers (CHWs) facilitate patients’ adoption of healthy behaviors. In September 2011 to January 2012, we conducted a qualitative study that triangulated multiple data sources: 26 in-depth interviews, training documents, and patient charts. CHWs served as partners in health to immigrant Filipinos with hypertension, leveraging their cultural congruence with intervention participants, employing interpersonal communication techniques to build trust and rapport, providing social support, and assisting with health behavior change. To drive the field forward, this work can be expanded with framework testing that may influence future CHW training and interventions. PMID:25790405

  5. Electronic Health Record Meets Digital Library

    PubMed Central

    Humphreys, Betsy L.

    2000-01-01

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

  6. The effect of hospital-physician integration on health information technology adoption.

    PubMed

    Lammers, Eric

    2013-10-01

    The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co-invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology. PMID:23055450

  7. The effect of hospital-physician integration on health information technology adoption.

    PubMed

    Lammers, Eric

    2013-10-01

    The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co-invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology.

  8. Syndromic Surveillance Using Ambulatory Electronic Health Records

    PubMed Central

    Hripcsak, George; Soulakis, Nicholas D.; Li, Li; Morrison, Frances P.; Lai, Albert M.; Friedman, Carol; Calman, Neil S.; Mostashari, Farzad

    2009-01-01

    Objective To assess the performance of electronic health record data for syndromic surveillance and to assess the feasibility of broadly distributed surveillance. Design Two systems were developed to identify influenza-like illness and gastrointestinal infectious disease in ambulatory electronic health record data from a network of community health centers. The first system used queries on structured data and was designed for this specific electronic health record. The second used natural language processing of narrative data, but its queries were developed independently from this health record. Both were compared to influenza isolates and to a verified emergency department chief complaint surveillance system. Measurements Lagged cross-correlation and graphs of the three time series. Results For influenza-like illness, both the structured and narrative data correlated well with the influenza isolates and with the emergency department data, achieving cross-correlations of 0.89 (structured) and 0.84 (narrative) for isolates and 0.93 and 0.89 for emergency department data, and having similar peaks during influenza season. For gastrointestinal infectious disease, the structured data correlated fairly well with the emergency department data (0.81) with a similar peak, but the narrative data correlated less well (0.47). Conclusions It is feasible to use electronic health records for syndromic surveillance. The structured data performed best but required knowledge engineering to match the health record data to the queries. The narrative data illustrated the potential performance of a broadly disseminated system and achieved mixed results. PMID:19261941

  9. Health Care Professionals' Perceptions of the Use of Electronic Medical Records

    ERIC Educational Resources Information Center

    Adeyeye, Adebisi

    2015-01-01

    Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals' perceptions of the use of EMRs at a hospital division of a…

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

    ERIC Educational Resources Information Center

    Huang, Yuan-Han

    2013-01-01

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

  11. Stigma, social context, and mental health: lesbian and gay couples across the transition to adoptive parenthood.

    PubMed

    Goldberg, Abbie E; Smith, JuliAnna Z

    2011-01-01

    This is the first study to examine change in depression and anxiety across the first year of adoptive parenthood in same-sex couples (90 couples: 52 lesbian, 38 gay male). Given that sexual minorities uniquely contend with sexual orientation-related stigma, this study examined how both internalized and enacted forms of stigma affect the mental health of lesbians and gay men during the transition to parenthood. In addition, the role of contextual support was examined. Higher perceived workplace support, family support, and relationship quality were related to lower depressive and anxious symptoms at the time of the adoption, and higher perceived friend support was related to lower anxiety symptoms. Lower internalized homophobia and higher perceived neighborhood gay-friendliness were related to lower depressive symptoms. Finally, individuals with high internalized homophobia who lived in states with unfavorable legal climates regarding gay adoption experienced the steepest increases in depressive and anxious symptoms. Findings have important implications for counselors working with sexual minorities, especially those experiencing the transition to parenthood.

  12. Setting priorities for the adoption of health technologies on a national level -- the Israeli experience.

    PubMed

    Shani, S; Siebzehner, M I; Luxenburg, O; Shemer, J

    2000-12-01

    The rapid development of new and expensive health technologies together with the limited resources available for the health care system, makes priority setting or rationing inevitable. The Israeli Health Insurance Law, enacted in 1995, determined a basic list of health services to be provided to all residents by public funding. Although the Israeli health care system has reached a high standard of medical care as expressed by parameters such as long life expectancy and low infant mortality, the social and professional demand for new and expensive health technologies is increasing. Towards the fiscal year of 1999, the Medical Technologies Administration of the Ministry of Health recommended a list of new technologies to be added to the list of health services. The Ministry of Finance allocated that year US dollars 35 million for this purpose, while a rough assessment found that there are new important technologies to be added at a cost of more than US dollars 350 million. The Medical Technologies Administration took a systematic approach of health technology assessment - ad-hoc teams were established for evaluating clinical safety, efficacy and effectiveness, conducting needs assessment and cost-effectiveness descriptions. Assessment of the data was based on evidence-based medicine. A set of criteria was determined in order to enable the prioritizing of the assessed new technologies. This procedure led to a list of technologies suggested for inclusion. The Minister of Health appointed a public committee whose purpose was to decide the technologies to be added to the list of health services. The committee, made up of representatives from the government, the sick-funds and the public, had to evaluate each technology, based on the analysis submitted to the committee, taking into consideration clinical, economic, social, ethical and legal aspects according to predefined criteria. The thorough work of the Medical Technologies Administration enabled the committee to adopt

  13. Setting priorities for the adoption of health technologies on a national level -- the Israeli experience.

    PubMed

    Shani, S; Siebzehner, M I; Luxenburg, O; Shemer, J

    2000-12-01

    The rapid development of new and expensive health technologies together with the limited resources available for the health care system, makes priority setting or rationing inevitable. The Israeli Health Insurance Law, enacted in 1995, determined a basic list of health services to be provided to all residents by public funding. Although the Israeli health care system has reached a high standard of medical care as expressed by parameters such as long life expectancy and low infant mortality, the social and professional demand for new and expensive health technologies is increasing. Towards the fiscal year of 1999, the Medical Technologies Administration of the Ministry of Health recommended a list of new technologies to be added to the list of health services. The Ministry of Finance allocated that year US dollars 35 million for this purpose, while a rough assessment found that there are new important technologies to be added at a cost of more than US dollars 350 million. The Medical Technologies Administration took a systematic approach of health technology assessment - ad-hoc teams were established for evaluating clinical safety, efficacy and effectiveness, conducting needs assessment and cost-effectiveness descriptions. Assessment of the data was based on evidence-based medicine. A set of criteria was determined in order to enable the prioritizing of the assessed new technologies. This procedure led to a list of technologies suggested for inclusion. The Minister of Health appointed a public committee whose purpose was to decide the technologies to be added to the list of health services. The committee, made up of representatives from the government, the sick-funds and the public, had to evaluate each technology, based on the analysis submitted to the committee, taking into consideration clinical, economic, social, ethical and legal aspects according to predefined criteria. The thorough work of the Medical Technologies Administration enabled the committee to adopt

  14. Electronic Health Record Use a Bitter Pill for Many Physicians

    PubMed Central

    Meigs, Stephen L.; Solomon, Michael

    2016-01-01

    Electronic health record (EHR) adoption among office-based physician practices in the United States has increased significantly in the past decade. However, the challenges of using EHRs have resulted in growing dissatisfaction with the systems among many of these physicians. The purpose of this qualitative multiple-case study was to increase understanding of physician perceptions regarding the value of using EHR technology. Important findings included the belief among physicians that EHR systems need to be more user-friendly and adaptable to individual clinic workflow preferences, physician beliefs that lack of interoperability among EHRs is a major barrier to meaningful use of the systems, and physician beliefs that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among office-based physician practices have produced positive results, additional support may be required in the future to maintain this momentum. PMID:26903782

  15. Medical Issues in Adoption

    MedlinePlus

    ... to Know About Zika & Pregnancy Medical Issues in Adoption KidsHealth > For Parents > Medical Issues in Adoption Print ... or emotional abuse of the child continue Agency Adoptions If you adopt through an agency, you might ...

  16. Experiences of Adopting Blended Pedagogies in Health Assessment Course in Post RN Baccalaureate Program of Nursing in Karachi, Pakistan

    ERIC Educational Resources Information Center

    Cassum, Shanaz Hussein; Allana, Saleema; Dias, Jacqueline

    2016-01-01

    Purpose: There is little known about whether faculty and students in a resource constricted context experience a change in learning due to the adoption of blended learning (BL) pedagogies in a lab based course. The study aimed to understand the experiences of faculty and students' related to the adoption of BL pedagogies in health assessment…

  17. Adoption Space and the Idea-to-Market Process of Health Technologies.

    PubMed

    Saranummi, Niilo; Beuscart, Regis; Black, Norman; Maglaveras, Nicos; Strano, Chiara; Karavidopoulou, Youla

    2016-01-01

    Although Europe 'produces' excellent science, it has not been equally successful in translating scientific results into commercially successful companies in spite of European and national efforts invested in supporting the translation process. The Idea-to-Market process is highly complex due to the large number of actors and stakeholders. ITECH was launched to propose recommendations which would accelerate the Idea-to-Market process of health technologies leading to improvements in the competitiveness of the European health technology industry in the global markets. The project went through the following steps: defining the Idea-to-Market process model; collection and analysis of funding opportunities; identification of 12 gaps and barriers in the Idea-to-Market process; a detailed analysis of these supported by interviews; a prioritization process to select the most important issues; construction of roadmaps for the prioritized issues; and finally generating recommendations and associated action plans. Seven issues were classified as in need of actions. Three of these are part of the ongoing Medical Device Directive Reform (MDR), namely health technology assessment, post-market surveillance and regulatory process, and therefore not within the scope of ITECH. Recommendations were made for eHealth taxonomy; Education and training; Clinical trials and Adoption space and Human Factors Engineering (HFE). PMID:27225546

  18. Adoption of a microbial health-based target for Australian drinking water regulation.

    PubMed

    O'Toole, Joanne; Sinclair, Martha; Gibney, Katherine; Leder, Karin

    2015-09-01

    The health-based targets of 1 in 10,000 for infection and 10(-6) disability adjusted life years (DALYs) per person per year are increasingly being considered, or have already been adopted, to define microbial safety targets for water. The aim of this paper is to convey information about how these two targets compare by converting each of the target values to a common metric. The metric chosen for viral (rotavirus and norovirus) and protozoan (Cryptosporidium) reference pathogens is the estimated maximum number of annual drinking water-associated cases of acute diarrhoeal disease tolerated. For the reference bacterial pathogen Campylobacter, sequelae to acute diarrhoeal illness have also been considered in estimating the tolerable number of cases for the DALY target. Also investigated is whether non-compliance with targets would be detected as a waterborne disease outbreak by the health surveillance system in an extreme hypothetical situation whereby all tolerable cases per annum occurred as a single event. The paper highlights that verification of compliance with targets cannot be demonstrated by the absence of reported drinking water-associated outbreaks alone and concludes that introduction of a quantitative health-based outcome for drinking water in Australia would help improve water quality management by providing a common goal directly linked to health outcomes.

  19. Adoption Space and the Idea-to-Market Process of Health Technologies.

    PubMed

    Saranummi, Niilo; Beuscart, Regis; Black, Norman; Maglaveras, Nicos; Strano, Chiara; Karavidopoulou, Youla

    2016-01-01

    Although Europe 'produces' excellent science, it has not been equally successful in translating scientific results into commercially successful companies in spite of European and national efforts invested in supporting the translation process. The Idea-to-Market process is highly complex due to the large number of actors and stakeholders. ITECH was launched to propose recommendations which would accelerate the Idea-to-Market process of health technologies leading to improvements in the competitiveness of the European health technology industry in the global markets. The project went through the following steps: defining the Idea-to-Market process model; collection and analysis of funding opportunities; identification of 12 gaps and barriers in the Idea-to-Market process; a detailed analysis of these supported by interviews; a prioritization process to select the most important issues; construction of roadmaps for the prioritized issues; and finally generating recommendations and associated action plans. Seven issues were classified as in need of actions. Three of these are part of the ongoing Medical Device Directive Reform (MDR), namely health technology assessment, post-market surveillance and regulatory process, and therefore not within the scope of ITECH. Recommendations were made for eHealth taxonomy; Education and training; Clinical trials and Adoption space and Human Factors Engineering (HFE).

  20. National electronic health record interoperability chronology.

    PubMed

    Hufnagel, Stephen P

    2009-05-01

    The federal initiative for electronic health record (EHR) interoperability began in 2000 and set the stage for the establishment of the 2004 Executive Order for EHR interoperability by 2014. This article discusses the chronology from the 2001 e-Government Consolidated Health Informatics (CHI) initiative through the current congressional mandates for an aligned, interoperable, and agile DoD AHLTA and VA VistA.

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

    PubMed

    Pharow, Peter; Blobel, Bernd

    2004-01-01

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

  2. The relevance of netnography to the harness of Romanian health care electronic word-of-mouth.

    PubMed

    Bratucu, R; Gheorghe, I R; Radu, A; Purcarea, V L

    2014-09-15

    Nowadays, consumers use the computer mediated communication to make purchase decisions on a large variety of products and services. Since health care services are archetypal by nature, consumers in this field are one of the most encountered users of electronic word-of-mouth. The objective of this paper is to explain and support the necessity of adopting a different qualitative method when electronic word of mouth is harnessed on health care dedicated forums, that is, netnography. PMID:25408755

  3. The relevance of netnography to the harness of Romanian health care electronic word-of-mouth

    PubMed Central

    Bratucu, R; Gheorghe, IR; Radu, A; Purcarea, VL

    2014-01-01

    Abstract Nowadays, consumers use the computer mediated communication to make purchase decisions on a large variety of products and services. Since health care services are archetypal by nature, consumers in this field are one of the most encountered users of electronic word-of-mouth. The objective of this paper is to explain and support the necessity of adopting a different qualitative method when electronic word of mouth is harnessed on health care dedicated forums, that is, netnography. PMID:25408755

  4. The relevance of netnography to the harness of Romanian health care electronic word-of-mouth.

    PubMed

    Bratucu, R; Gheorghe, I R; Radu, A; Purcarea, V L

    2014-09-15

    Nowadays, consumers use the computer mediated communication to make purchase decisions on a large variety of products and services. Since health care services are archetypal by nature, consumers in this field are one of the most encountered users of electronic word-of-mouth. The objective of this paper is to explain and support the necessity of adopting a different qualitative method when electronic word of mouth is harnessed on health care dedicated forums, that is, netnography.

  5. Patient Perceptions of Electronic Health Records

    ERIC Educational Resources Information Center

    Lulejian, Armine

    2011-01-01

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

  6. Barriers to implement Electronic Health Records (EHRs)

    PubMed Central

    Ajami, Sima; Arab-Chadegani, Razieh

    2013-01-01

    Introduction: During the past 20 years, with huge advances in information technology and particularly in the areas of health, various forms of electronic records have been studied, analyzed, designed or implemented. An Electronic Health Records (EHRs) is defined as digitally stored healthcare information throughout an individual’s lifetime with the purpose of supporting continuity of care, education, and research. The EHRs may include such things as observations, laboratory tests, medical images, treatments, therapies; drugs administered, patient identifying information, legal permissions, and so on. Despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction ,that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints. Aim: The aim of this study was to express the main barriers to implement EHRs. Methods: This study was unsystematic-review study. The literature was searched on main barriers to implement EHRs with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the following keywords and their combinations: Electronic health record, implement, obstacle, and information technology in the searching areas of title, keywords, abstract, and full text. Results and discussion: In this study, more than 43 articles and reports were collected and 32 of them were selected based on their relevancy. Many studies indicate that the most important factor than other limitations to implement the EHR are resistance to change. PMID:24167440

  7. Characteristics of early adopters of end-user online searching in the health professions.

    PubMed

    Marshall, J G

    1989-01-01

    This paper examines end-user, online searching using data from a questionnaire mailed to 150 Canadian health professionals in practice settings. The response rate was 83% (n = 124). The data provide a demographic profile of early adopters of end-user searching in the health care community. Positive correlations with the user's level of implementation of end-user searching were found for the following variables: amount of time spent in research activities, amount of system training received, and use of Medical Subject Headings (MeSH). There was a negative association between the amount of time spent in patient care and implementation level. General practitioners and family physicians had lower implementation levels than physicians in other specialties. Successful implementers were more likely to be computer literate and to place a high value on formal information sources such as books, journals, and libraries. Health professionals using so-called "user-friendly" or menu-based software had lower levels of personal commitment to using online databases, as measured by a combination of continuance of use, willingness to pay personally, type of recommendations made to colleagues, and hardware ownership.

  8. Adopting and adapting managed competition: health care reform in Southern Europe.

    PubMed

    Cabiedes, L; Guillén, A

    2001-04-01

    A new paradigm appeared in Europe in the early 1990 s regarding the reform of health care systems. This paradigm has come to be known as the managed competition paradigm, among other terms. First introduced in Great Britain, it entails the separation of the financing/purchasing and providing functions, so that competition among providers is enhanced, while maintaining universal access and public financing, at least in principle. This article explores to what extent such paradigm has been emulated within the Greek, Italian, Portuguese and Spanish health care systems. Reform in the direction of managed competition may be ascertained in all four countries. However, each country has emphasized different aspects of the paradigm, and the degree and rhythm of implementation of reform has varied. The article considers the circumstances under which the new paradigm was born, and its main characteristics; analyzes actual reforms in Southern European countries; and provides a tentative explanation of the diffusion mechanisms. It concludes that the crucial factor explaining the different paths of policy adoption and adaptation is the character of the initial health care system.

  9. Access Control Model for Sharing Composite Electronic Health Records

    NASA Astrophysics Data System (ADS)

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

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

  10. Ethical issues in electronic health records: A general overview

    PubMed Central

    Ozair, Fouzia F.; Jamshed, Nayer; Sharma, Amit; Aggarwal, Praveen

    2015-01-01

    Electronic health record (EHR) is increasingly being implemented in many developing countries. It is the need of the hour because it improves the quality of health care and is also cost-effective. Technologies can introduce some hazards hence safety of information in the system is a real challenge. Recent news of security breaches has put a question mark on this system. Despite its increased usefulness, and increasing enthusiasm in its adoption, not much attention is being paid to the ethical issues that might arise. Securing EHR with an encrypted password is a probable option. The purpose of this article is to discuss the various ethical issues arising in the use of the EHRs and their possible solutions. PMID:25878950

  11. Teaching Electronic Health Record Communication Skills.

    PubMed

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

    2016-06-01

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

  12. Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration

    PubMed Central

    Sperber, Nina R.; Andrews, Sara M.; Voils, Corrine I.; Green, Gregory L.; Provenzale, Dawn; Knight, Sara

    2016-01-01

    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines. PMID:27136589

  13. Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration.

    PubMed

    Sperber, Nina R; Andrews, Sara M; Voils, Corrine I; Green, Gregory L; Provenzale, Dawn; Knight, Sara

    2016-01-01

    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines. PMID:27136589

  14. Addressing Barriers to the Development and Adoption of Rapid Diagnostic Tests in Global Health

    PubMed Central

    Miller, Eric; Sikes, Hadley D.

    2015-01-01

    Immunochromatographic rapid diagnostic tests (RDTs) have demonstrated significant potential for use as point-of-care diagnostic tests in resource-limited settings. Most notably, RDTs for malaria have reached an unparalleled level of technological maturity and market penetration, and are now considered an important complement to standard microscopic methods of malaria diagnosis. However, the technical development of RDTs for other infectious diseases, and their uptake within the global health community as a core diagnostic modality, has been hindered by a number of extant challenges. These range from technical and biological issues, such as the need for better affinity agents and biomarkers of disease, to social, infrastructural, regulatory and economic barriers, which have all served to slow their adoption and diminish their impact. In order for the immunochromatographic RDT format to be successfully adapted to other disease targets, to see widespread distribution, and to improve clinical outcomes for patients on a global scale, these challenges must be identified and addressed, and the global health community must be engaged in championing the broader use of RDTs. PMID:26594252

  15. Resveratrol and health from a consumer perspective: perception, attitude, and adoption of a new functional ingredient.

    PubMed

    Aschemann-Witzel, Jessica; Grunert, Klaus G

    2015-08-01

    Resveratrol is an ingredient widely researched, with growing evidence of health-promoting effects. However, the reactions of supplement or food consumers to resveratrol has not been researched, and the ingredient is yet unknown to most consumers. We used respective literature and our own resveratrol consumer studies with Danish and U.S. consumers to look at current findings and future research directions for three questions. (1) Which factors determine consumer interest in a yet unknown functional ingredient such as resveratrol? (2) How should resveratrol be marketed as a new functional ingredient to be understood and favorably perceived? (3) What could be the effects of adoption of an ingredient such as resveratrol on the healthy lifestyle of a consumer? Literature and first results indicate that personal relevance and familiarity are crucial factors; however, consumers show little interest in resveratrol and lack relevant knowledge, especially in Denmark. Favorable attitudes were explained by health outcome expectations, use of complementary and alternative medicine, and interest in the indulgence dimension of food. Nonscientifically phrased communication led to more favorable attitudes in Danish consumers; scientifically phrased communication, though, made U.S. consumers more likely to retain favorable attitudes in the presence of contradictory evidence. We discuss future research directions in different cultural backgrounds and market contexts and for different foods. PMID:26315295

  16. Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration.

    PubMed

    Sperber, Nina R; Andrews, Sara M; Voils, Corrine I; Green, Gregory L; Provenzale, Dawn; Knight, Sara

    2016-04-28

    We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines.

  17. Resveratrol and health from a consumer perspective: perception, attitude, and adoption of a new functional ingredient.

    PubMed

    Aschemann-Witzel, Jessica; Grunert, Klaus G

    2015-08-01

    Resveratrol is an ingredient widely researched, with growing evidence of health-promoting effects. However, the reactions of supplement or food consumers to resveratrol has not been researched, and the ingredient is yet unknown to most consumers. We used respective literature and our own resveratrol consumer studies with Danish and U.S. consumers to look at current findings and future research directions for three questions. (1) Which factors determine consumer interest in a yet unknown functional ingredient such as resveratrol? (2) How should resveratrol be marketed as a new functional ingredient to be understood and favorably perceived? (3) What could be the effects of adoption of an ingredient such as resveratrol on the healthy lifestyle of a consumer? Literature and first results indicate that personal relevance and familiarity are crucial factors; however, consumers show little interest in resveratrol and lack relevant knowledge, especially in Denmark. Favorable attitudes were explained by health outcome expectations, use of complementary and alternative medicine, and interest in the indulgence dimension of food. Nonscientifically phrased communication led to more favorable attitudes in Danish consumers; scientifically phrased communication, though, made U.S. consumers more likely to retain favorable attitudes in the presence of contradictory evidence. We discuss future research directions in different cultural backgrounds and market contexts and for different foods.

  18. Longitudinal pressure ulcer rates since the adoption of culture change in Veterans Health Administration nursing homes

    PubMed Central

    Hartmann, Christine W.; Shwartz, Michael; Zhao, Shibei; Palmer, Jennifer A.; Berlowitz, Dan R.

    2015-01-01

    Objective To examine facility-level pressure ulcer development rates and variations in these rates after a system-wide adoption of culture change in Veterans Health Administration (VHA) nursing homes. Design 4-year retrospective longitudinal design. Setting 109 VHA facilities representing 132 nursing homes, known as Community Living Centers (CLCs). Measurements Pressure ulcers were identified using FY08-11 Minimum Data Set (MDS) data. Pressure ulcer development was defined as a stage 2 or larger pressure ulcer on an MDS assessment with no pressure ulcer on the previous assessment. A risk adjustment model was developed using 105,274 MDS observations to predict the likelihood of pressure ulcers (c statistic = 0.72). A Bayesian hierarchical model that adjusted for differences in the precision of pressure ulcer rates from differently sized facilities was used to calculate smoothed risk-adjusted (SRA) rates for each facility. The statistical significance of the trend over the 4 years was determined by examining the 95% interval estimate for the slope. Results Over the 4 year period, the beginning of which coincided with the VHA’s system-wide adoption of culture change as a performance measure, median SRA facility pressure ulcer development rates were fairly consistent at approximately 4%. The range in SRA rates declined from 14.8% to 10.1%. Some facilities had significantly improving SRA rates (e.g., declined steadily from 5.5% to 3.9%) and some had significantly worsening SRA rates (e.g., increased steadily from 5.1% to 7.9%). Seven sites had significantly improving rates (p<.001) that were below the median across all 4 years. Conclusion CLC pressure ulcer development rates were unaffected by a system-wide culture change implementation. There was, however, significant variation in facility rates and some facilities exhibited sustained high performance. PMID:26782865

  19. Legal Considerations for Electronic Health Records.

    PubMed

    Mostofi, Sherry; Hoffman, Andrew L

    2015-05-01

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

  20. Legal Considerations for Electronic Health Records.

    PubMed

    Mostofi, Sherry; Hoffman, Andrew L

    2015-05-01

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

  1. Electronic health records: current and future use.

    PubMed

    Peters, Steve G; Khan, Munawwar A

    2014-09-01

    This paper provides an overview of the current state of the electronic medical record, including benefits and shortcomings, and presents key factors likely to drive development in the next decade and beyond. The current electronic medical record to a large extent represents a digital version of the traditional paper legal record, owned and maintained by the practitioner. The future electronic health record is expected to be a shared tool, engaging patients in decision making, wellness and disease management and providing data for individual decision support, population management and analytics. Many drivers will determine this path, including payment model reform, proliferation of mobile platforms, telemedicine, genomics and individualized medicine and advances in 'big data' technologies.

  2. Modelling and implementing electronic health records in Denmark.

    PubMed

    Bernstein, Knut; Bruun-Rasmussen, Morten; Vingtoft, Søren; Andersen, Stig Kjaer; Nøhr, Christian

    2005-03-01

    The Danish Health IT strategy [Danish Ministry of Interior and Health, National Strategy for IT in the Health Sector 2003-2007, Copenhagen, 2003 (in Danish). http://www.im.dk/publikationer/itstrategi/itstrategi.pdf. notes that integration between electronic health records (EHR) systems has a high priority. A prerequisite for real integration and semantic interoperability is agreement of the data content and the information models. The National Board of Health is working on a common model for EHR, and its adoption is now being promoted through pilot projects. At the same time, several development and implementation projects are taking place at a regional level. These EHRs are built on information models from different vendors and are based on different integration platforms. The Danish EHR observatory, which has been monitoring the development of EHRs in Denmark since 1998, has analysed the challenges of using different information models and integration platforms. This paper also maps the development in Denmark to the new paradigms in modelling techniques and integration technology. PMID:15694627

  3. Benefits and drawbacks of electronic health record systems

    PubMed Central

    Menachemi, Nir; Collum, Taleah H

    2011-01-01

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

  4. Electronic communication improves access, but barriers to its widespread adoption remain

    PubMed Central

    Bishop, Tara F.; Press, Matthew J.; Mendelsohn, Jayme L.; Casalino, Lawrence P.

    2013-01-01

    Principles of patient-centered care imply that physicians should use electronic communication with patients more extensively, including as a substitute for office visits when clinically appropriate. We interviewed leaders of 21 medical groups that use electronic communication with patients extensively and also interviewed staff in six of these groups. Electronic communication was widely perceived to be a safe, effective and efficient means of communication that improves patient satisfaction and saves patients time, but increases the volume of physician work unless office visits are reduced. Practice redesign and new payment methods are likely necessary for electronic communication to be used more extensively. PMID:23918479

  5. How the Electronic Health Record Will Change the Future of Health Care

    PubMed Central

    Ronquillo, Jeremiah Geronimo

    2012-01-01

    Genetic testing is expected to play a critical role in patient care in the near future. Advances in genomic research have the potential to impact medicine in very tangible and direct ways, from carrier screening to disease diagnosis and prognosis to targeted treatments and personalized medicine. However, numerous barriers to widespread adoption of genetic testing continue to exist, and health information technology will be a critical means of addressing these challenges. Electronic health records (EHRs) are a digital replacement for the traditional paper-based patient chart designed to improve the quality of patient care. EHRs have become increasingly essential to managing the wealth of existing clinical information that now includes genetic information extracted from the patient genome. The EHR is capable of changing health care in the future by transforming the way physicians use genomic information in the practice of medicine. PMID:23012585

  6. Integrating Electronic Health Record Competencies into Undergraduate Health Informatics Education.

    PubMed

    Borycki, Elizabeth M; Griffith, Janessa; Kushniruk, Andre W

    2016-01-01

    In this paper we report on our findings arising from a qualitative, interview study of students' experiences in an undergraduate health informatics program. Our findings suggest that electronic health record competencies need to be integrated into an undergraduate curriculum. Participants suggested that there is a need to educate students about the use of the EHR, followed by best practices around interface design, workflow, and implementation with this work culminating in students spearheading the design of the technology as part of their educational program of study. PMID:27577461

  7. Electronic Health Record Application Support Service Enablers.

    PubMed

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

    2015-08-01

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

  8. Genetic Counselors’ Current Use of Personal Health Records-Based Family Histories in Genetic Clinics and Considerations for Their Future Adoption

    PubMed Central

    DeShazo, Jonathan P.; Bodurtha, Joann; Quillin, John; Creswick, Heather

    2016-01-01

    Given the widespread adoption of electronic medical records and recent emergence of electronic family history tools, we examined genetic counselors’ perspectives on the emerging technology of the personal health record (PHR)-based family history tool that links to an electronic medical record (EMR). Two-hundred thirty-three genetic counselors responded to an on-line survey eliciting current use of electronic family history (EFH) tools and familiarity with PHR-based family history tools. Additionally, after being shown a series of screen shots of a newly developed PHR-based family history tool based on the U.S. Surgeon General’s My Family Health Portrait (United States Department of Health and Human Services 2009), participants were surveyed about the perceived usefulness, ease of use, and impact on current workflow that this kind of tool would have in their practices. Eighty-three percent reported that their institution has an EMR, yet only 35 % have a dedicated space for family history. Eighty-two percent reported that less than 5 % of their patients have a PHR, and only 16 % have worked with patients who have a PHR. Seventy-two percent or more agreed that a PHR-based family history tool would facilitate communication, increase accuracy of information, ensure consistency in recording information, increase focus on actual counseling, reduce repetitive questions, improve efficiency, and increase the legibility and clarity. Our findings suggest that participants were familiar with existing EFH tools, but that the majority did not use them in practice. Genetic counselors’ adoption of such tools is limited due to non-existence of this kind of technology or inability to integrate it into their clinics. They are also strongly in favor of adopting a PHR-based family history tool in genetics clinics, but have practical concerns that must be addressed before the tool can be implemented. PMID:23242928

  9. [The model of state health policy and the system of medical assistance adopted in present-day Brazil].

    PubMed

    Queiroz, M de S; Vianna, A L

    1992-04-01

    A contribution to the analysis of the health reform presently occurring in Brazil is presented. The need to consolidate the theoretical background which supports the advances already achieved in order to understand recent events in the area is stressed. In this regard, the health reform is understood as a question transcending the mere administrative and managerial aspect of the health system, since it necessarily involves a redefinition of the concepts of health, disease and the medical practice adopted by the dominant mechanistic paradigm of medicine. The recent events which delineate the health system in Brazil are analysed and criticised in the light of this concern.

  10. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and...

  11. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and...

  12. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and...

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

    ERIC Educational Resources Information Center

    Zhang, Rui

    2013-01-01

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

  14. Mental Health Provider Attitudes Toward Adoption of Evidence-Based Practice: The Evidence-Based Practice Attitude Scale (EBPAS)

    PubMed Central

    Aarons, Gregory A.

    2006-01-01

    Mental health provider attitudes toward organizational change have not been well studied. Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined in relation to a set of provider individual difference and organizational characteristics. Methods Participants were 322 public sector clinical service workers from 51 programs providing mental health services to children and adolescents and their families. Results Four dimensions of attitudes toward adoption of EBPs were identified: (1) intuitive Appeal of EBP, (2) likelihood of adopting EBP given Requirements to do so, (3) Openness to new practices, and (4) perceived Divergence of usual practice with research-based/academically developed interventions. Provider attitudes varied by education level, level of experience, and organizational context. Conclusions Attitudes toward adoption of EBPs can be reliably measured and vary in relation to individual differences and service context. EBP implementation plans should include consideration of mental health service provider attitudes as a potential aid to improve the process and effectiveness of dissemination efforts. PMID:15224451

  15. Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

    PubMed Central

    2013-01-01

    Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required

  16. Technological trends in health care: electronic health record.

    PubMed

    Abraham, Sam

    2010-01-01

    The most relevant technological trend affecting health care organizations and physician services is the electronic health record (EHR). Billions of dollars from the federal government stimulus bill are available for investment toward EHR. Based on the government directives, it is evident EHR has to be a high-priority technological intervention in health care organizations. Addressed in the following pages are the effects of the EHR trend on financial and human resources; analysis of advantages and disadvantages of EHR; action steps involved in implementing EHR, and a timeline for implementation. Medical facilities that do not meet the timetable for using EHR will likely experience reduction of Medicare payments. This article also identifies the strengths, weaknesses, opportunities, and threats of the EHR and steps to be taken by hospitals and physician medical groups to receive stimulus payment.

  17. Quality and Certification of Electronic Health Records

    PubMed Central

    Hoerbst, A.; Ammenwerth, E.

    2010-01-01

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

  18. Executive function and mental health in adopted children with a history of recreational drug exposures.

    PubMed

    Piper, Brian J; Gray, Hilary M; Corbett, Selena M; Birkett, Melissa A; Raber, Jacob

    2014-01-01

    Adoptive children are at increased risk for problematic behaviors but the origin of these individual differences in neurobehavioral function is unclear. This investigation examined whether adopted children with prenatal exposure to a wide variety of recreational drugs exhibited higher scores (i.e. more problems) with executive function and psychiatric symptomology. Caregivers of children ages 5 to 18 completed an online survey with items about use of alcohol, nicotine, or methamphetamine during pregnancy followed by the Behavior Rating Inventory of Executive Function (BRIEF, N = 437 including 59 adoptive parents) or the Child Behavior Checklist (CBCL, N = 549 including 54 adoptive parents). Relative to a comparison group of children raised by their biological parents, adoptive children that were polysubstance exposed during prenatal development exhibited higher rates of academic difficulties and were behind their classmates in math and reading. Adoptive children had statistically and clinically significant higher BRIEF ratings and this pattern was similar for boys and girls. CBCL ratings were significantly increased in adoptive children, particularly for Externalizing and Attention problems. Adoptive children with a history of polysubstance exposures including alcohol, nicotine, and methamphetamine are at heightened risk for difficulties with executive function as well as various psychopathologies. These findings suggest that increased monitoring to identify and implement remediation strategies may be warranted for adopted children with a history of in utero drug exposures. PMID:25337917

  19. Executive Function and Mental Health in Adopted Children with a History of Recreational Drug Exposures

    PubMed Central

    Piper, Brian J.; Gray, Hilary M.; Corbett, Selena M.; Birkett, Melissa A.; Raber, Jacob

    2014-01-01

    Adoptive children are at increased risk for problematic behaviors but the origin of these individual differences in neurobehavioral function is unclear. This investigation examined whether adopted children with prenatal exposure to a wide variety of recreational drugs exhibited higher scores (i.e. more problems) with executive function and psychiatric symptomology. Caregivers of children ages 5 to 18 completed an online survey with items about use of alcohol, nicotine, or methamphetamine during pregnancy followed by the Behavior Rating Inventory of Executive Function (BRIEF, N = 437 including 59 adoptive parents) or the Child Behavior Checklist (CBCL, N = 549 including 54 adoptive parents). Relative to a comparison group of children raised by their biological parents, adoptive children that were polysubstance exposed during prenatal development exhibited higher rates of academic difficulties and were behind their classmates in math and reading. Adoptive children had statistically and clinically significant higher BRIEF ratings and this pattern was similar for boys and girls. CBCL ratings were significantly increased in adoptive children, particularly for Externalizing and Attention problems. Adoptive children with a history of polysubstance exposures including alcohol, nicotine, and methamphetamine are at heightened risk for difficulties with executive function as well as various psychopathologies. These findings suggest that increased monitoring to identify and implement remediation strategies may be warranted for adopted children with a history of in utero drug exposures. PMID:25337917

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

    PubMed Central

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

    2013-01-01

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

  1. Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations.

    PubMed

    Patterson, David A; Wolf Adelv Unegv Waya, Silver; Dulmus, Catherine N

    2012-06-01

    This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization's internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations.

  2. Organizational Barriers to Adopting an Alcohol Screening and Brief Intervention in Community-Based Mental Health Organizations

    PubMed Central

    Patterson, David A.; Wolf (Adelv unegv Waya), Silver; Dulmus, Catherine N.

    2012-01-01

    This paper examines two factors related to successfully implementing a brief alcohol screening throughout all community-based mental health organizations. The first issue is related to an organization’s internal structures, such as culture and climate that can impede evidenced-based practice implementation. There is literature suggesting that organizational culture and climate affect decisions about whether evidence-based practices are adopted and implemented within health care agencies. Following this literature review on organizational barriers, the history and successes of adopting an alcohol screening and brief intervention are reviewed. Studying, identifying, and understanding the organizational factors associated with the successful dissemination and implementation of best practices throughout community-based mental health organizations would contribute to increasing the likelihood that an alcohol screening and brief intervention are implemented throughout mental health organizations. PMID:24634639

  3. Transforming Education for Electronic Health Record Implementation.

    PubMed

    Nicklaus, Jennifer; Kusser, Janet; Zessin, Julie; Amaya, Michael

    2015-08-01

    Outcomes are an integral part of health care. Over the years, the educational team at the authors' hospital has sought effective, realistic options for electronic health record (EHR) training that ensures standardized documentation of patient data by nursing personnel. Thus, providers will have easily available access and clinicians will experience confidence in the proficiency of their skills to use the EHR. This article describes the transformation from an instructor-led classroom training plan into a focused clinician workflow training pathway using Benner's novice-to-expert model and Lowe's five Key Principles for Successful EHR Training. Multiple teaching strategies have been incorporated into the education plan, including a computer skills assessment test, an EHR proficiency tool, web-based training modules, clinical (or specialty) scenarios, followed by practice in learning laboratories. The educational plan has produced individualized EHR learning, confident nursing performance, and overall unit management satisfaction. PMID:26247658

  4. Practicing preventive ethics, protecting patients: challenges of the electronic health record.

    PubMed

    Satkoske, Valerie B; Parker, Lisa S

    2010-01-01

    Implementation of guidelines regarding breaches of electronic health information requires an anticipatory stance and physician and patient education regarding security and monitoring measures and methods of redress. Adopting a preventive ethics, rather than a crisis management, model may also increase physician awareness of how the information they choose to include and privilege within the health record may expose patients to added harms if not done mindfully.

  5. Implementing a network for electronic surveillance reporting from public health reference laboratories: an international perspective.

    PubMed Central

    Bean, N. H.; Martin, S. M.

    2001-01-01

    Electronic data reporting from public health laboratories to a central site provides a mechanism for public health officials to rapidly identify problems and take action to prevent further spread of disease. However, implementation of reference laboratory systems is much more complex than simply adopting new technology, especially in international settings. We describe three major areas to be considered by international organizations for successful implementation of electronic reporting systems from public health reference laboratories: benefits of electronic reporting, planning for system implementation (e.g., support, resources, data analysis, country sovereignty), and components of system initiation (e.g., authority, disease definition, feedback, site selection, assessing readiness, problem resolution). Our experience with implementation of electronic public health laboratory data management and reporting systems in the United States and working with international organizations to initiate similar efforts demonstrates that successful reference laboratory reporting can be implemented if surveillance issues and components are planned. PMID:11747687

  6. Adopting an Electronic Text Book for a Postgraduate Accounting Course: An Experiential Study

    ERIC Educational Resources Information Center

    Schoch, Herbert P.; Teoh, Hai Yap; Kropman, Margaret

    2006-01-01

    Students are becoming accustomed to using the Internet as an information source that supplements or replaces the normal institutional and classroom handout. However, the use of full electronic books through the Internet or CD instead of a printed full text book is a uniquely different experience, not only for these students but also for academics…

  7. Closing the Research-Practice Gap: Factors Affecting Adoption and Implementation of a Children's Mental Health Program

    ERIC Educational Resources Information Center

    Henderson, Joanna L.; MacKay, Sherri; Peterson-Badali, Michele

    2006-01-01

    Despite the availability of effective interventions, they are not widely used in community mental health centers. This study examined the adoption and implementation of The Arson Prevention Program for Children (TAPP-C), a program for juvenile firesetters developed at a teaching hospital and disseminated to community settings. Questionnaire data…

  8. Adoption of Web 2.0 Technologies in Education for Health Professionals in the UK: Where Are We and Why?

    ERIC Educational Resources Information Center

    Ward, Rod; Moule, Pam; Lockyer, Lesley

    2009-01-01

    This paper describes the findings about the use of Web 2.0 technologies in the education of health professionals in the United Kingdom (UK). The work is part of a wider study scoping the use of e-learning. Its objectives were to: (1) Explore issues influencing implementation and use by both early and late adopters; (2) Identify barriers to…

  9. Adoption and Use of a Mobile Health Application in Older Adults for Cognitive Stimulation.

    PubMed

    Yasini, Mobin; Marchand, Guillaume

    2016-01-01

    Serious games could be used to improve cognitive functions in the elderly. We evaluated the adoption of a new tablet application dedicated to cognitive stimulation in the elderly. The Stim'Art application offers various serious games to work different cognitive functions (memory, attention, concentration, etc.). The usage of fifteen older adults was followed for six months. The type of the game, the number of launches for each game, the time spent on each game, the difficulty level, the success rate and perceived well-being of users have been studied and compared at the end of the first and the sixth months. The participants have played half an hour per day on average. The average time of playing per day in the sixth month was significantly higher than the average time of playing during the first month (p value < 7 * 10(-4)). The same result was found for the average number of game launches per day (p value < 7 * 10(-4)). However, older people seem not to launch more difficult levels in the last month. The success rate at sixth months was significantly higher than the success rate at the end of the first month (p value < 6.4 * 1010(-4)). Generally, seniors have had an improvement in their wellbeing score judged by themselves. Our study showed that the mobile application receives a good admission from users. The results are promising and can pave the way for improving cognitive function in the elderly patients. The use of tablets and the constitution of serious games in close cooperation with health professionals and elderly patients (the end user), are likely to provide satisfactory results to improve healthcare provided for elderly patients suffering from cognitive disorders.

  10. Use of Electronic Health Records in Residential Care Communities

    MedlinePlus

    ... billing purposes, does this facility use electronic health records? This is a computerized version of the resident's health and personal information used in the management of the resident's health care." All providers were ...

  11. Bringing electronic patient records into health professional education: towards an integrative framework.

    PubMed

    Kushniruk, Andre W; Borycki, Elizabeth M; Armstrong, Brian; Joe, Ron; Otto, Tony

    2009-01-01

    In this paper we discuss our approach for integrating electronic patient records into health professional education. Electronic patient record (EPR) use is increasing globally. The EPR is considered the cornerstone of the modernization and streamlining of healthcare worldwide. However, despite the importance of the EPR, health professional education in much of the world provides health professional students (who will become the practicing health professionals of the future) with limited access or knowledge about the EPR. New ways of exposing students to EPRs will be needed in order to ensure that health professionals will adopt and use this complex technology wisely and effect the positive benefits EPRs are expected to bring to healthcare globally. In this paper we describe: (a) a framework we have developed for integrating EPRs into health professional education and (b) an innovative Web portal, known as the University of Victoria Electronic Health Record (EHR) Educational Portal (which houses a number of EPRs) that can be used to explore the integration of EPRs in health professional education. It is hoped that adoption and use of EPRs will ultimately be improved through the use of the portal to allow students virtual and ubiquitous access to example EPRs, coupled with principled educational approaches for integrating EPR technology into health professional curricula.

  12. Assessing Factors Affecting Physician's Intention to Adopt Biometric Authentication Technology in Electronic Medical Records

    ERIC Educational Resources Information Center

    Corazao, Cesar E.

    2014-01-01

    The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulated the privacy and security of patient information. Since HIPPA became a law, hospital operators have struggled to comply fully with its security and privacy provisions. The proximity-based biometric authentication (PBBA) technology evolved in last decade to help…

  13. mHealth adoption in low-resource environments: a review of the use of mobile healthcare in developing countries.

    PubMed

    Chib, Arul; van Velthoven, Michelle Helena; Car, Josip

    2015-01-01

    The acknowledged potential of using mobile phones for improving healthcare in low-resource environments of developing countries has yet to translate into significant mHealth policy investment. The low uptake of mHealth in policy agendas may stem from a lack of evidence of the scalable, sustainable impact on health indicators. The mHealth literature in low- and middle-income countries reveals a burgeoning body of knowledge; yet, existing reviews suggest that the projects yield mixed results. This article adopts a stage-based approach to understand the varied contributions to mHealth research. The heuristic of inputs-mechanism-outputs is proposed as a tool to categorize mHealth studies. This review (63 articles comprising 53 studies) reveals that mHealth studies in developing countries tend to concentrate on specific stages, principally on pilot projects that adopt a deterministic approach to technological inputs (n = 32), namely introduction and implementation. Somewhat less studied were research designs that demonstrate evidence of outputs (n = 15), such as improvements in healthcare processes and public health indicators. The review finds a lack of emphasis on studies that provide theoretical understanding (n = 6) of adoption and appropriation of technological introduction that produces measurable health outcomes. As a result, there is a lack of dominant theory, or measures of outputs relevant to making policy decisions. Future work needs to aim for establishing theoretical and measurement standards, particularly from social scientific perspectives, in collaboration with researchers from the domains of information technology and public health. Priorities should be set for investments and guidance in evaluation disseminated by the scientific community to practitioners and policymakers. PMID:24673171

  14. Organ Procurement Organizations and the Electronic Health Record.

    PubMed

    Howard, R J; Cochran, L D; Cornell, D L

    2015-10-01

    The adoption of electronic health records (EHRs) has adversely affected the ability of organ procurement organizations (OPOs) to perform their federally mandated function of honoring the donation decisions of families and donors who have signed the registry. The difficulties gaining access to potential donor medical record has meant that assessment, evaluation, and management of brain dead organ donors has become much more difficult. Delays can occur that can lead to potential recipients not receiving life-saving organs. For over 40 years, OPO personnel have had ready access to paper medical records. But the widespread adoption of EHRs has greatly limited the ability of OPO coordinators to readily gain access to patient medical records and to manage brain dead donors. Proposed solutions include the following: (1) hospitals could provide limited access to OPO personnel so that they could see only the potential donor's medical record; (2) OPOs could join with other transplant organizations to inform regulators of the problem; and (3) hospital organizations could be approached to work with Center for Medicare and Medicaid Services (CMS) to revise the Hospital Conditions of Participation to require OPOs be given access to donor medical records.

  15. Predictability Bounds of Electronic Health Records

    PubMed Central

    Dahlem, Dominik; Maniloff, Diego; Ratti, Carlo

    2015-01-01

    The ability to intervene in disease progression given a person’s disease history has the potential to solve one of society’s most pressing issues: advancing health care delivery and reducing its cost. Controlling disease progression is inherently associated with the ability to predict possible future diseases given a patient’s medical history. We invoke an information-theoretic methodology to quantify the level of predictability inherent in disease histories of a large electronic health records dataset with over half a million patients. In our analysis, we progress from zeroth order through temporal informed statistics, both from an individual patient’s standpoint and also considering the collective effects. Our findings confirm our intuition that knowledge of common disease progressions results in higher predictability bounds than treating disease histories independently. We complement this result by showing the point at which the temporal dependence structure vanishes with increasing orders of the time-correlated statistic. Surprisingly, we also show that shuffling individual disease histories only marginally degrades the predictability bounds. This apparent contradiction with respect to the importance of time-ordered information is indicative of the complexities involved in capturing the health-care process and the difficulties associated with utilising this information in universal prediction algorithms. PMID:26148751

  16. Disassociation for electronic health record privacy.

    PubMed

    Loukides, Grigorios; Liagouris, John; Gkoulalas-Divanis, Aris; Terrovitis, Manolis

    2014-08-01

    The dissemination of Electronic Health Record (EHR) data, beyond the originating healthcare institutions, can enable large-scale, low-cost medical studies that have the potential to improve public health. Thus, funding bodies, such as the National Institutes of Health (NIH) in the U.S., encourage or require the dissemination of EHR data, and a growing number of innovative medical investigations are being performed using such data. However, simply disseminating EHR data, after removing identifying information, may risk privacy, as patients can still be linked with their record, based on diagnosis codes. This paper proposes the first approach that prevents this type of data linkage using disassociation, an operation that transforms records by splitting them into carefully selected subsets. Our approach preserves privacy with significantly lower data utility loss than existing methods and does not require data owners to specify diagnosis codes that may lead to identity disclosure, as these methods do. Consequently, it can be employed when data need to be shared broadly and be used in studies, beyond the intended ones. Through extensive experiments using EHR data, we demonstrate that our method can construct data that are highly useful for supporting various types of clinical case count studies and general medical analysis tasks.

  17. Matrix Analysis of the Digital Divide in eHealth Services Using Awareness, Want, and Adoption Gap

    PubMed Central

    2012-01-01

    Background The digital divide usually refers to access or usage, but some studies have identified two other divides: awareness and demand (want). Given that the hierarchical stages of the innovation adoption process of a customer are interrelated, it is necessary and meaningful to analyze the digital divide in eHealth services through three main stages, namely, awareness, want, and adoption. Objective By following the three main integrated stages of the innovation diffusion theory, from the customer segment viewpoint, this study aimed to propose a new matrix analysis of the digital divide using the awareness, want, and adoption gap ratio (AWAG). I compared the digital divide among different groups. Furthermore, I conducted an empirical study on eHealth services to present the practicability of the proposed methodology. Methods Through a review and discussion of the literature, I proposed hypotheses and a new matrix analysis. To test the proposed method, 3074 Taiwanese respondents, aged 15 years and older, were surveyed by telephone. I used the stratified simple random sampling method, with sample size allocation proportioned by the population distribution of 23 cities and counties (strata). Results This study proposed the AWAG segment matrix to analyze the digital divide in eHealth services. First, awareness and want rates were divided into two levels at the middle point of 50%, and then the 2-dimensional cross of the awareness and want segment matrix was divided into four categories: opened group, desire-deficiency group, perception-deficiency group, and closed group. Second, according to the degrees of awareness and want, each category was further divided into four subcategories. I also defined four possible strategies, namely, hold, improve, evaluate, and leave, for different regions in the proposed matrix. An empirical test on two recently promoted eHealth services, the digital medical service (DMS) and the digital home care service (DHCS), was conducted

  18. Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study

    PubMed Central

    2011-01-01

    Background Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perceptions of the benefits and problems of electronic information exchange in health care and the n-EPR in particular. Methods The study was conducted in three Dutch health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, interviews were conducted with 17 stakeholders working in these organisations. Relevant themes were deduced by means of thematic qualitative analysis. Results Health care providers perceived electronic information exchange to promote the efficiency and quality of care. The problems they perceived in electronic information exchange mainly concerned the confidentiality and safety of information exchange and the reliability and quality of patient data. Many problems perceived by health care providers did not specifically apply to the n-EPR, but to electronic information exchange in general. Conclusions The implementation of the Dutch n-EPR has mainly followed a top-down approach, thereby neglecting the fact that the perceptions and preferences of its users (health care providers) need to be addressed in order to achieve successful implementation. The results of this study provide valuable suggestions about how to promote health care providers' willingness to adopt electronic information exchange, which can be useful for other countries currently implementing an n-EPR. Apart from providing information about the benefits and usefulness of electronic information exchange, efforts should be focused on minimising the problems as perceived by health care providers. The safety and

  19. Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

    PubMed

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

    The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

  20. Change management with the electronic health record.

    PubMed

    Schmucker, DeeAnn

    2009-01-01

    Many medical organizations have already changed to, are implementing, or are contemplating implementing an electronic health record (EHR) system. As in all change, some people accept the switch from paper to EHRs much easier and with more enthuiasm than others. It is common for organizations to overlook the importance of including change management properties as they create the overall plan for the change from paper to paperless. Often the result of this is anger, frustration, and lack of cooperation or even sabotage from physicians and office staff who are the recipients of the training on the EHR system. This article examines the steps for, opportunities for, and positive results from incorporating change management principles from the very beginning, and the benefits accrued by understanding and utilizing the concepts of good choices, relationships, planning, and feedback.

  1. Evaluation of Knowledge, Attitude, Practise and Adoption Among Health Care Professionals for Informatics/Computerised Technology Systems.

    PubMed

    Karthik, Kavitha; Munuswamy, Suresh

    2016-01-01

    This proposed study will be conducted in Telangana and Tamil Nadu states in India. Mapping of Health care Professionals by a web-based Delphi technique followed by Focus Group Discussion and Evaluation of Knowledge, Attitude, Practise and Adoption among Health Care Professionals for informatics/computerised technology systems by using structured questionnaire for knowledge and practice and for Attitudes toward Computers in Healthcare (P.A.T.C.H.) Scale will be used to collect the data. This study results will create evidence on present and relevant informatics/computerized technology systems needs and help the research team to develop informatics competencies list and design an online or offline skill up gradation programs for health professionals in India according to their diverse roles in the health care system. The researcher team believes these results will have National relevance to the current focus areas of Government of India and to strengthen the Health Informatics Program offered in IIPH, Hyderabad.

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

    PubMed

    Graves, Stuart

    2013-01-01

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

  3. [Electronic cigarettes - effects on health. Previous reports].

    PubMed

    Napierała, Marta; Kulza, Maksymilian; Wachowiak, Anna; Jabłecka, Katarzyna; Florek, Ewa

    2014-01-01

    Currently very popular in the market of tobacco products have gained electronic cigarettes (ang. E-cigarettes). These products are considered to be potentially less harmful in compared to traditional tobacco products. However, current reports indicate that the statements of the producers regarding to the composition of the e- liquids not always are sufficient, and consumers often do not have reliable information on the quality of the product used by them. This paper contain a review of previous reports on the composition of e-cigarettes and their impact on health. Most of the observed health effects was related to symptoms of the respiratory tract, mouth, throat, neurological complications and sensory organs. Particularly hazardous effects of the e-cigarettes were: pneumonia, congestive heart failure, confusion, convulsions, hypotension, aspiration pneumonia, face second-degree burns, blindness, chest pain and rapid heartbeat. In the literature there is no information relating to passive exposure by the aerosols released during e-cigarette smoking. Furthermore, the information regarding to the use of these products in the long term are not also available.

  4. Comparing concepts for electronic health record architectures.

    PubMed

    Blobel, Bernd

    2002-01-01

    Keeping all relevant information directly or indirectly related to patient's care, electronic health records (EHR) systems are supposed to be kernel application for any kind of health information systems. For facilitating shared care, managed care, or disease management, such EHR systems have to be scalable, portable, distributed, and interoperable which has to be enabled by a proper architecture supporting informational and functional needs as well. Advanced EHR architectures are based on object-oriented or component-oriented paradigms and use modern tooling to design, specify, implement and maintain EHR solutions. They reflect not only medical information but also underlying concepts and integrate an extended vocabulary. The most advanced EHR architecture approaches CEN ENV 13606, G-CPR, HL7 RIM and derived models, and finally the Australian GEHR project are shortly characterised. For comparing the solutions, the ISO RM - ODP, the Generic Component Model and the CORBA 3 methodology have been used. The HARP methodology for enhancing the current harmonisation of openEHR is shortly discussed.

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

    ERIC Educational Resources Information Center

    Brown, Viseeta K.

    2012-01-01

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

  6. National-level differences in the adoption of environmental health technologies: a cross-border comparison from Benin and Togo.

    PubMed

    Wendland, Kelly J; Pattanayak, Subhrendu K; Sills, Erin O

    2015-03-01

    Environmental health problems such as malaria, respiratory infections, diarrhoea and malnutrition pose very high burdens on the poor rural people in much of the tropics. Recent research on key interventions-the adoption and use of relatively cheap and effective environmental health technologies-has focused primarily on the influence of demand-side household-level drivers. Relatively few studies of the promotion and use of these technologies have considered the role of contextual factors such as governance, the enabling environment and national policies because of the challenges of cross-country comparisons. We exploit a natural experimental setting by comparing household adoption across the Benin-Togo national border that splits the Tamberma Valley in West Africa. Households across the border share the same culture, ethnicity, weather, physiographic features, livelihoods and infrastructure; however, they are located in countries at virtually opposite ends of the institutional spectrum of democratic elections, voice and accountability, effective governance and corruption. Binary choice models and rigorous non-parametric matching estimators confirm that households in Benin are more likely than households in Togo to plant soybeans, build improved cookstoves and purchase mosquito nets, ceteris paribus. Although we cannot identify the exact mechanism for the large and significant national-level differences in technology adoption, our findings suggest that contextual institutional factors can be more important than household characteristics for technology adoption.

  7. National-level differences in the adoption of environmental health technologies: a cross-border comparison from Benin and Togo.

    PubMed

    Wendland, Kelly J; Pattanayak, Subhrendu K; Sills, Erin O

    2015-03-01

    Environmental health problems such as malaria, respiratory infections, diarrhoea and malnutrition pose very high burdens on the poor rural people in much of the tropics. Recent research on key interventions-the adoption and use of relatively cheap and effective environmental health technologies-has focused primarily on the influence of demand-side household-level drivers. Relatively few studies of the promotion and use of these technologies have considered the role of contextual factors such as governance, the enabling environment and national policies because of the challenges of cross-country comparisons. We exploit a natural experimental setting by comparing household adoption across the Benin-Togo national border that splits the Tamberma Valley in West Africa. Households across the border share the same culture, ethnicity, weather, physiographic features, livelihoods and infrastructure; however, they are located in countries at virtually opposite ends of the institutional spectrum of democratic elections, voice and accountability, effective governance and corruption. Binary choice models and rigorous non-parametric matching estimators confirm that households in Benin are more likely than households in Togo to plant soybeans, build improved cookstoves and purchase mosquito nets, ceteris paribus. Although we cannot identify the exact mechanism for the large and significant national-level differences in technology adoption, our findings suggest that contextual institutional factors can be more important than household characteristics for technology adoption. PMID:24436179

  8. Stigma, Social Context, and Mental Health: Lesbian and Gay Couples across the Transition to Adoptive Parenthood

    ERIC Educational Resources Information Center

    Goldberg, Abbie E.; Smith, JuliAnna Z.

    2011-01-01

    This is the first study to examine change in depression and anxiety across the first year of adoptive parenthood in same-sex couples (90 couples: 52 lesbian, 38 gay male). Given that sexual minorities uniquely contend with sexual orientation-related stigma, this study examined how both internalized and enacted forms of stigma affect the mental…

  9. Factors Influencing the Adoption of a Health Promoting School Approach in the Province of Quebec, Canada

    ERIC Educational Resources Information Center

    Deschesnes, M.; Trudeau, F.; Kebe, M.

    2010-01-01

    This study examined a prediction model that integrated three categories of predictors likely to influence adoption of the Quebec Healthy Schools (HS) approach, i.e. attributes of the approach, individual and contextual characteristics. HS receptivity was considered as a potential mediator. For this study, 141 respondents representing 96 schools…

  10. 77 FR 22949 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-17

    ... FR 3328) in which the Secretary of HHS (the Secretary) adopted the ICD-10-CM and ICD-10-PCS (ICD-10... Federal Register on August 22, 2008 (73 FR 49742); ``HIPAA Administrative Simplification: Modification to... Federal Register on August 22, 2008 (73 FR 49796) (hereinafter referred to as the ICD-10 proposed...

  11. Health Education Textbook Adoption in Texas: A Lesson in Politics and Morality

    ERIC Educational Resources Information Center

    Wiley, David; Barr, Elissa

    2007-01-01

    Textbooks are often a core element of curricula and delivery of classroom instruction and have long been a source of controversy. The textbook adoption process has become less about content and more about political/cultural pressure. Special-interest groups from the right and left exert enormous influence on textbook content through bias and…

  12. An Exploration of the Adoption of Public Health Degrees and Certificates in Community Colleges

    ERIC Educational Resources Information Center

    Kirkwood, Brenda A.

    2012-01-01

    Efforts aimed at strengthening the governmental public health workforce have led to increased attention on undergraduate public health education. The focus, to date, has been on four-year institutions with minimal attention provided to community, or two-year, colleges and their potential role in addressing public health workforce needs. Progress…

  13. Factors Driving the Adoption of Quality Improvement Initiatives in Local Health Departments: Results From the 2010 Profile Study

    PubMed Central

    Luo, Huabin; Sotnikov, Sergey; McLees, Anita; Stokes, Shereitte

    2016-01-01

    Background Over the past decade, quality improvement (QI) has become a major focus in advancing the goal of improving performance of local health departments (LHDs). However, limited empirical data exists on the current implementation of QI initiatives in LHDs and factors associated with adoption of QI initiatives. Objectives (1) To examine the current implementation of QI implementation initiatives by LHDs and (2) to identify factors contributing to LHDs’ decision to implement QI initiatives. Methods In this study, a novel theoretical framework based on analysis of QI in medicine was applied to analyze QI by LHDs. LHDs’ QI adoption was assessed by the number of formal QI projects reported by LHDs that responded to module 1 of the 2010 National Profile of Local Health Department Study (Profile Study) conducted by the National Association of County & City Health Officials. The Profile Study data were merged with data from the Health Resources and Services Administration’s Area Resource Files and the Association of State and Territorial Health Officials’ 2010 Survey. Logistic regression analyses were conducted using Stata 11 SVY procedure to account for the complex sampling design. Results The Profile Study data indicated that about 73% of the LHDs reported implementing 1 or more QI projects. LHDs with large jurisdiction population (>50 000), higher per capita public health expenditure, a designated QI staff member, or prior participation in performance improvement programs were more likely to have undertaken QI initiatives. Conclusion According to the Profile Study, more than a quarter of LHDs surveyed did not report implementing any formal QI projects. Greater investments in QI programs and designation of QI staff can be effective strategies to promote QI adoption. The validity of the definition of a formal QI project needs to be established. More research to identify the barriers to successful QI implementation at LHDs is also needed. PMID:24978615

  14. Australian health professionals' social media (Web 2.0) adoption trends: early 21st century health care delivery and practice promotion.

    PubMed

    Usher, Wayne T

    2012-01-01

    This study was concerned with identifying reasons behind patterns of social media (Web 2.0) usage associated with eight of Australia's major health professions. Attention was given to uncovering some of the more significant motivations for the resistance or adoption of Web 2.0 technologies for health care delivery and practice promotion by Australian health professionals. Surveys were developed from a common set of questions with specific variations between professions negotiated with professional health societies. Survey questions were constructed in an attempt to identify Web 2.0 adoption trends. An online survey (www.limesurvey.org) was used to collect data. Initial data preparation involved the development of one integrated SPSS file to incorporate all responses from the eight surveys undertaken. Initial data analysis applied Frequencies and Crosstabs to the identified groups and provided a profile of respondents by key business and demographic characteristics. Of the 935 respondents, 9.5% of participants indicated that they used Web 2.0 for their professional work, 19.1% of them did not use it for work but used it for their personal needs and 71.3% of them did not use Web 2.0 at all. Participants have indicated that the main reason for 'choosing not to adopt' Web 2.0 applications as a way of delivering health care to their patients is due to the health professionals' lack of understanding of Web 2.0 (83.3%), while the main reason for 'choosing to adopt' Web 2.0 applications is the perception of Web 2.0 as a quick and effective method of communication (73.0%). This study has indicated that Australian health professionals 'choose not to adopt' Web 2.0 usage as a way of delivering health care primarily due to 'a lack of understanding as to how social media would be used in health care' (83.3%). This study identifies that Australian health professionals are interacting with Web 2.0 technologies in their private lives but are failing to see how such technologies

  15. Health information technology: standards, implementation specifications, and certification criteria for electronic health record technology, 2014 edition; revisions to the permanent certification program for health information technology. Final rule.

    PubMed

    2012-09-01

    With this final rule, the Secretary of Health and Human Services adopts certification criteria that establish the technical capabilities and specify the related standards and implementation specifications that Certified Electronic Health Record (EHR) Technology will need to include to, at a minimum, support the achievement of meaningful use by eligible professionals, eligible hospitals, and critical access hospitals under the Medicare and Medicaid EHR Incentive Programs beginning with the EHR reporting periods in fiscal year and calendar year 2014. This final rule also makes changes to the permanent certification program for health information technology, including changing the program's name to the ONC HIT Certification Program. PMID:22946139

  16. Health information technology: standards, implementation specifications, and certification criteria for electronic health record technology, 2014 edition; revisions to the permanent certification program for health information technology. Final rule.

    PubMed

    2012-09-01

    With this final rule, the Secretary of Health and Human Services adopts certification criteria that establish the technical capabilities and specify the related standards and implementation specifications that Certified Electronic Health Record (EHR) Technology will need to include to, at a minimum, support the achievement of meaningful use by eligible professionals, eligible hospitals, and critical access hospitals under the Medicare and Medicaid EHR Incentive Programs beginning with the EHR reporting periods in fiscal year and calendar year 2014. This final rule also makes changes to the permanent certification program for health information technology, including changing the program's name to the ONC HIT Certification Program.

  17. Worksite Tobacco Prevention: A Randomized, Controlled Trial of Adoption, Dissemination Strategies, and Aggregated Health-Related Outcomes across Companies.

    PubMed

    Friedrich, Verena; Brügger, Adrian; Bauer, Georg F

    2015-01-01

    Evidence based public health requires knowledge about successful dissemination of public health measures. This study analyses (a) the changes in worksite tobacco prevention (TP) in the Canton of Zurich, Switzerland, between 2007 and 2009; (b1) the results of a multistep versus a "brochure only" dissemination strategy; (b2) the results of a monothematic versus a comprehensive dissemination strategy that aim to get companies to adopt TP measures; and (c) whether worksite TP is associated with health-related outcomes. A longitudinal design with randomized control groups was applied. Data on worksite TP and health-related outcomes were gathered by a written questionnaire (baseline n = 1627; follow-up n = 1452) and analysed using descriptive statistics, nonparametric procedures, and ordinal regression models. TP measures at worksites improved slightly between 2007 and 2009. The multistep dissemination was superior to the "brochure only" condition. No significant differences between the monothematic and the comprehensive dissemination strategies were observed. However, improvements in TP measures at worksites were associated with improvements in health-related outcomes. Although dissemination was approached at a mass scale, little change in the advocated adoption of TP measures was observed, suggesting the need for even more aggressive outreach or an acceptance that these channels do not seem to be sufficiently effective. PMID:26504778

  18. Worksite Tobacco Prevention: A Randomized, Controlled Trial of Adoption, Dissemination Strategies, and Aggregated Health-Related Outcomes across Companies

    PubMed Central

    Friedrich, Verena; Brügger, Adrian; Bauer, Georg F.

    2015-01-01

    Evidence based public health requires knowledge about successful dissemination of public health measures. This study analyses (a) the changes in worksite tobacco prevention (TP) in the Canton of Zurich, Switzerland, between 2007 and 2009; (b1) the results of a multistep versus a “brochure only” dissemination strategy; (b2) the results of a monothematic versus a comprehensive dissemination strategy that aim to get companies to adopt TP measures; and (c) whether worksite TP is associated with health-related outcomes. A longitudinal design with randomized control groups was applied. Data on worksite TP and health-related outcomes were gathered by a written questionnaire (baseline n = 1627; follow-up n = 1452) and analysed using descriptive statistics, nonparametric procedures, and ordinal regression models. TP measures at worksites improved slightly between 2007 and 2009. The multistep dissemination was superior to the “brochure only” condition. No significant differences between the monothematic and the comprehensive dissemination strategies were observed. However, improvements in TP measures at worksites were associated with improvements in health-related outcomes. Although dissemination was approached at a mass scale, little change in the advocated adoption of TP measures was observed, suggesting the need for even more aggressive outreach or an acceptance that these channels do not seem to be sufficiently effective. PMID:26504778

  19. Using community based participatory research as a method for investigating electronic health records.

    PubMed

    Almond, Helen; Cummings, Elizabeth; Turner, Paul

    2015-01-01

    One information source for the Personally Controlled Electronic Health Record is the consumer repository. This paper reports on the use of community based participatory research, as a project method, derived from an initiative where people with complex chronic conditions and their carers attended a rural health promotion and lifestyle modification program. Through co-operative inquiry embedded in the research approach, health promotion workers and their clients were actively supported to adopt and use the PCEHR as an intervention. Simultaneously they were encouraged to reflect on its design, mechanisms for its implementation and their perceptions of its overall impact on consumer's ability to self-manage complex conditions. PMID:25676944

  20. Evaluating the Usability of a Free Electronic Health Record for Training

    PubMed Central

    Hoyt, Robert; Adler, Kenneth; Ziesemer, Brandy; Palombo, Georgina

    2013-01-01

    The United States will need to train a large workforce of skilled health information technology (HIT) professionals in order to meet the US government's goal of universal electronic health records (EHRs) for all patients and widespread health information exchange. The Health Information Technology for Economic and Clinical Health (HITECH) Act established several HIT workforce educational programs to accomplish this goal. Recent studies have shown that EHR usability is a significant concern of physicians and is a potential obstacle to EHR adoption. It is important to have a highly usable EHR to train both clinicians and students. In this article, we report a qualitative-quantitative usability analysis of a web-based EHR for training health informatics and health information management students. PMID:23805062

  1. Adopting public health approaches to communication disability: challenges for the education of speech-language pathologists.

    PubMed

    Wylie, Karen; McAllister, Lindy; Davidson, Bronwyn; Marshall, Julie; Law, James

    2014-01-01

    Public health approaches to communication disability challenge the profession of speech-language pathology (SLP) to reconsider both frames of reference for practice and models of education. This paper reviews the impetus for public health approaches to communication disability and considers how public health is, and could be, incorporated into SLP education, both now and in the future. The paper describes tensions between clinical services, which have become increasingly specialized, and public health approaches that offer a broader view of communication disability and communication disability prevention. It presents a discussion of these tensions and asserts that public health approaches to communication are themselves a specialist field, requiring specific knowledge and skills. The authors suggest the use of the term 'communication disability public health' to refer to this type of work and offer a preliminary definition in order to advance discussion. Examples from three countries are provided of how some SLP degree programmes are integrating public health into the SLP curriculum. Alternative models of training for communication disability public health that may be relevant in the future in different contexts and countries are presented, prompting the SLP profession to consider whether communication disability public health is a field of practice for speech-language pathologists or whether it has broader workforce implications. The paper concludes with some suggestions for the future which may advance thinking, research and practice in communication disability public health.

  2. Adoption of new health products in low and middle income settings: how product development partnerships can support country decision making

    PubMed Central

    2011-01-01

    When a new health product becomes available, countries have a choice to adopt the product into their national health systems or to pursue an alternate strategy to address the public health problem. Here, we describe the role for product development partnerships (PDPs) in supporting this decision-making process. PDPs are focused on developing new products to respond to health problems prevalent in low and middle income settings. The impact of these products within public sector health systems can only be realized after a country policy process. PDPs may be the organizations most familiar with the evidence which assists decision making, and this generally translates into involvement in international policy development, but PDPs have limited reach into endemic countries. In a few individual countries, there may be more extensive involvement in tracking adoption activities and generating local evidence. This local PDP involvement begins with geographical prioritization based on disease burden, relationships established during clinical trials, PDP in-country resources, and other factors. Strategies adopted by PDPs to establish a presence in endemic countries vary from the opening of country offices to engagement of part-time consultants or with long-term or ad hoc committees. Once a PDP commits to support country decision making, the approaches vary, but include country consultations, regional meetings, formation of regional, product-specific committees, support of in-country advocates, development of decision-making frameworks, provision of technical assistance to aid therapeutic or diagnostic guideline revision, and conduct of stakeholder and Phase 4 studies. To reach large numbers of countries, the formation of partnerships, particularly with WHO, are essential. At this early stage, impact data are limited. But available evidence suggests PDPs can and do play an important catalytic role in their support of country decision making in a number of target countries. PMID

  3. Testing the Electronic Personal Health Record Acceptance Model by Nurses for Managing Their Own Health

    PubMed Central

    Trinkoff, A.M.; Storr, C.L.; Wilson, M.L.; Gurses, A.P.

    2015-01-01

    Summary Background To our knowledge, no evidence is available on health care professionals’ use of electronic personal health records (ePHRs) for their health management. We therefore focused on nurses’ personal use of ePHRs using a modified technology acceptance model. Objectives To examine (1) the psychometric properties of the ePHR acceptance model, (2) the associations of perceived usefulness, ease of use, data privacy and security protection, and perception of self as health-promoting role models to nurses’ own ePHR use, and (3) the moderating influences of age, chronic illness and medication use, and providers’ use of electronic health record (EHRs) on the associations between the ePHR acceptance constructs and ePHR use. Methods A convenience sample of registered nurses, those working in one of 12 hospitals in the Maryland and Washington, DC areas and members of the nursing informatics community (AMIA and HIMSS), were invited to respond to an anonymous online survey; 847 responded. Multiple logistic regression identified associations between the model constructs and ePHR use, and the moderating effect. Results Overall, ePHRs were used by 47%. Sufficient reliability for all scales was found. Three constructs were significantly related to nurses’ own ePHR use after adjusting for covariates: usefulness, data privacy and security protection, and health-promoting role model. Nurses with providers that used EHRs who perceived a higher level of data privacy and security protection had greater odds of ePHR use than those whose providers did not use EHRs. Older nurses with a higher self-perception as health-promoting role models had greater odds of ePHR use than younger nurses. Conclusions Nurses who use ePHRs for their personal health might promote adoption by the general public by serving as health-promoting role models. They can contribute to improvements in patient education and ePHR design, and serve as crucial resources when working with their

  4. 77 FR 54663 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-05

    ...: Effective date: These regulations are effective on November 5, 2012. Compliance dates: Health plans with the... January 23, 2004 Federal Register (69 FR 3434), the U.S. Department of Health and Human Services (HHS... the January 16, 2009 Federal Register (74 FR 3328), HHS published a final rule in which the...

  5. Adoption of Soil Health Improvement Strategies by Australian Farmers: II. Impediments and Incentives

    ERIC Educational Resources Information Center

    Bennett, J. McL.; Cattle, S. R.

    2014-01-01

    Purpose: Many farmers remain hesitant to implement structured management plans and strategies tailored to address soil health, irrespective of mounting scientific evidence for the credibility of certain soil health indicators, an increase in the reporting of program benefits and progress in communicating these benefits. Hence, the purpose of this…

  6. Adoption of Soil Health Improvement Strategies by Australian Farmers: I. Attitudes, Management and Extension Implications

    ERIC Educational Resources Information Center

    Bennett, J. McL.; Cattle, S. R.

    2013-01-01

    Purpose: There is inconsistency in the design, understanding, implementation and monitoring of soil health programmes. Despite mounting scientific evidence for the credibility of certain soil health indicators, an increase in the reporting of programme benefits, and progress in communicating these benefits, many farmers remain hesitant to…

  7. Use of Local Health Department Websites: A Study of E-Government Adoption and Diffusion

    ERIC Educational Resources Information Center

    Aaltonen, Pamela Massie

    2013-01-01

    Two distinct but converging activities have the potential to alter the way local public health departments conduct business. These activities are the emergence of e-government and the addition of preparedness as a basic function of the public health system. Preparedness implies timely collaboration with government entities, community partners and…

  8. Can Social Cognitive Theories Help Us Understand Nurses' Use of Electronic Health Records?

    PubMed

    Strudwick, Gillian; Booth, Richard; Mistry, Kartini

    2016-04-01

    Electronic health record implementations have accelerated in clinical settings around the world in an effort to improve patient safety and enhance efficiencies related to care delivery. As the largest group of healthcare professionals globally, nurses play an important role in the use of these records and ensuring their benefits are realized. Social cognitive theories such as the Theory of Reasoned Action, Theory of Planned Behaviour, and the Technology Acceptance Model have been developed to explain behavior. Given that variation in nurses' electronic health record utilization may influence the degree to which benefits are realized, the aim of this article is to explore how the use of these social cognitive theories may assist organizations implementing electronic health records to facilitate deeper-level adoption of this type of clinical technology.

  9. Can Social Cognitive Theories Help Us Understand Nurses' Use of Electronic Health Records?

    PubMed

    Strudwick, Gillian; Booth, Richard; Mistry, Kartini

    2016-04-01

    Electronic health record implementations have accelerated in clinical settings around the world in an effort to improve patient safety and enhance efficiencies related to care delivery. As the largest group of healthcare professionals globally, nurses play an important role in the use of these records and ensuring their benefits are realized. Social cognitive theories such as the Theory of Reasoned Action, Theory of Planned Behaviour, and the Technology Acceptance Model have been developed to explain behavior. Given that variation in nurses' electronic health record utilization may influence the degree to which benefits are realized, the aim of this article is to explore how the use of these social cognitive theories may assist organizations implementing electronic health records to facilitate deeper-level adoption of this type of clinical technology. PMID:26844529

  10. An examination of electronic health information privacy in older adults.

    PubMed

    Le, Thai; Thompson, Hilaire; Demiris, George

    2013-01-01

    Older adults are the quickest growing demographic group and are key consumers of health services. As the United States health system transitions to electronic health records, it is important to understand older adult perceptions of privacy and security. We performed a secondary analysis of the Health Information National Trends Survey (2012, Cycle 1), to examine differences in perceptions of electronic health information privacy between older adults and the general population. We found differences in the level of importance placed on access to electronic health information (older adults placed greater emphasis on provider as opposed to personal access) and tendency to withhold information out of concerns for privacy and security (older adults were less likely to withhold information). We provide recommendations to alleviate some of these privacy concerns. This may facilitate greater use of electronic health communication between patient and provider, while promoting shared decision making.

  11. Feasibility of Automatic Extraction of Electronic Health Data to Evaluate a Status Epilepticus Clinical Protocol.

    PubMed

    Hafeez, Baria; Paolicchi, Juliann; Pon, Steven; Howell, Joy D; Grinspan, Zachary M

    2016-05-01

    Status epilepticus is a common neurologic emergency in children. Pediatric medical centers often develop protocols to standardize care. Widespread adoption of electronic health records by hospitals affords the opportunity for clinicians to rapidly, and electronically evaluate protocol adherence. We reviewed the clinical data of a small sample of 7 children with status epilepticus, in order to (1) qualitatively determine the feasibility of automated data extraction and (2) demonstrate a timeline-style visualization of each patient's first 24 hours of care. Qualitatively, our observations indicate that most clinical data are well labeled in structured fields within the electronic health record, though some important information, particularly electroencephalography (EEG) data, may require manual abstraction. We conclude that a visualization that clarifies a patient's clinical course can be automatically created using the patient's electronic clinical data, supplemented with some manually abstracted data. Future work could use this timeline to evaluate adherence to status epilepticus clinical protocols.

  12. Adopting customers' empowerment and social networks to encourage participations in e-health services.

    PubMed

    Anshari, Muhammad; Almunawar, Mohammad Nabil; Low, Patrick Kim Cheng; Wint, Zaw; Younis, Mustafa Z

    2013-01-01

    The aim of this article is to present an e-health model that embeds empowerment and social network intervention that may extend the role of customers in health care settings. A 25-item Likert-type survey instrument was specifically developed for this study and administered to a sample of 108 participants in Indonesia from October to November 2012. The data were analyzed to provide ideas on how to move forward with the e-health initiative as a means to improve e-health services. The survey revealed that there is a high demand for customers' empowerment and involvement in social networks to improve their health literacy and customer satisfaction. Regardless of the limitations of the study, the participants have responded with great support for the abilities of the prototype systems drawn from the survey. The survey results were used as requirements to develop a system prototype that incorporates the expectations of the people. The prototype (namely Clinic 2.0) was derived from the model and confirmed from the survey. Participants were selected to use the system for three months, after which we measured its impact towards their health literacy and customer satisfaction. The results show that the system intervention through Clinic 2.0 leads to a high level of customer satisfaction and health literacy. PMID:24551960

  13. Ten key considerations for the successful implementation and adoption of large-scale health information technology

    PubMed Central

    Cresswell, Kathrin M; Bates, David W; Sheikh, Aziz

    2013-01-01

    The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale health information technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, health directorates, healthcare management, and senior clinicians. PMID:23599226

  14. Intergovernmental relations in physician education and health planning: state adoption decisions and the impact of federal programs.

    PubMed

    Durand, R; Nelson, S L; Patel, K

    1982-10-01

    This study seeks to explain states' adoptions of programs in health planning and in physician education. It also seeks to further understanding of the impact of federal health planning and education programs on the states. Several theories and models are employed in analyzing the actions of state decision-makers. These include incremental theory, models of the diffusion of innovations, economic resources theory, and a theory of competitive partisanship. The data utilized in this research were principally derived from intensive interviews with "key" state actors and from historical, documentary materials. Only minimal federal impact appears on states' goals in physician education and health planning. Rather, there is evidence of considerable innovativeness among the states prior to Federal program initiatives. A problem-generated search for solutions seems to be a major source of this innovation. Finally, federal program implementation requirements appear to be a major source of federal--state conflict and opposition.

  15. Balancing Good Intentions: Protecting the Privacy of Electronic Health Information

    ERIC Educational Resources Information Center

    McClanahan, Kitty

    2008-01-01

    Electronic information is a vital but complex component in the modern health care system, fueling ongoing efforts to develop a universal electronic health record infrastructure. This innovation creates a substantial tension between two desirable values: the increased quality and utility of patient medical records and the protection of the privacy…

  16. Impact on the Performance of Health Workers Adopted Performance-Related Contracts in the Provision of Basic Public Health Service At Village and Township Levels

    PubMed Central

    ZHAO, Yaojun; HUO, Zhen’ang; WU, Jian; XIE, Shuangbao; ZHANG, Liang; FENG, Zhanchun

    2013-01-01

    Background This paper focus on the impact on the performance of health workers at village and township levels in the provision of a government stipulated package of basic public health service, which adopted the performance-related contracts mode. Methods: The concept of balanced scorecard was adopted and developed to gather the 11 evaluation indicators distributed in four quadrants. These were implemented using on-site questionnaire and interview design. Four thousand and twenty-one respondents at 30 administrative villages including 2674 respondents at 20 pilot villages and 1347 at 10 control villages were investigated. Meanwhile, 62 administration officials from three counties and nine townships were interviewed. Results: Eight of 11 evaluation indicators were obviously better in pilot counties than in Control County, The remaining three indicators respectively represented that equal, inferior to control county, and could not clear judge. Conclusion: The performance of health workers at village and township levels in the provision of basic public health service in pilot counties, which adopted the performance-related contracts mode, is better than before and control county. PMID:23785674

  17. Examining factors that influence the adoption of health-promoting behaviours among people with venous disease.

    PubMed

    Miller, Charne; Kapp, Suzanne; Donohue, Lisa

    2014-04-01

    People living with venous disease are encouraged to make a number of behaviour modifications to facilitate healing and to prevent a recurrence of a venous leg ulcer. This investigation sought to examine factors described in the literature that shape the effectiveness of multi-component education programs and conduct a secondary analysis of data to examine relationships between various health behaviours for people with a venous leg ulcer who participated in a standardised e-learning education program. This study found few statistically significant and typically minor relationships between health behaviours after participants had completed the education program. No significant differences were identified by participant gender, age or need for a carer, for either the number of health behaviours performed after the education or the number of behaviour changes made during the education. Participants performing few of the recommended health-promoting behaviours prior to the education achieved more behaviour change than those already engaged in the sought after activities [F(2,154) = 16·038, P = 0·000]. The notable lack of associations between the performance of the health-promoting behaviours places emphasis on the need for comprehensive investigation of the moderators and mediators of multi-faceted behaviour change to promote wound healing and chronic disease management.

  18. “Big Data” and the Electronic Health Record

    PubMed Central

    Ross, M. K.; Wei, Wei

    2014-01-01

    Summary Objectives Implementation of Electronic Health Record (EHR) systems continues to expand. The massive number of patient encounters results in high amounts of stored data. Transforming clinical data into knowledge to improve patient care has been the goal of biomedical informatics professionals for many decades, and this work is now increasingly recognized outside our field. In reviewing the literature for the past three years, we focus on “big data” in the context of EHR systems and we report on some examples of how secondary use of data has been put into practice. Methods We searched PubMed database for articles from January 1, 2011 to November 1, 2013. We initiated the search with keywords related to “big data” and EHR. We identified relevant articles and additional keywords from the retrieved articles were added. Based on the new keywords, more articles were retrieved and we manually narrowed down the set utilizing predefined inclusion and exclusion criteria. Results Our final review includes articles categorized into the themes of data mining (pharmacovigilance, phenotyping, natural language processing), data application and integration (clinical decision support, personal monitoring, social media), and privacy and security. Conclusion The increasing adoption of EHR systems worldwide makes it possible to capture large amounts of clinical data. There is an increasing number of articles addressing the theme of “big data”, and the concepts associated with these articles vary. The next step is to transform healthcare big data into actionable knowledge. PMID:25123728

  19. 76 FR 40457 - Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    ... in the Federal Register on August 22, 2008 (73 FR 49742). Congress addressed the need for a... cost than manual transactions. In the August 17, 2000 Federal Register (65 FR 50312) we published a... Act (HIPAA) Electronic Transaction Standards'' (74 FR 3296) (hereinafter referred to as...

  20. SHORT-RUN SUBSIDIES AND LONG-RUN ADOPTION OF NEW HEALTH PRODUCTS: EVIDENCE FROM A FIELD EXPERIMENT

    PubMed Central

    Dupas, Pascaline

    2014-01-01

    Short-run subsidies for health products are common in poor countries. How do they affect long-run adoption? A common fear among development practitioners is that one-off subsidies may negatively affect long-run adoption through reference-dependence: People might anchor around the subsidized price and be unwilling to pay more for the product later. But for experience goods, one-off subsidies could also boost long-run adoption through learning. This paper uses data from a two-stage randomized pricing experiment in Kenya to estimate the relative importance of these effects for a new, improved antimalarial bed net. Reduced form estimates show that a one-time subsidy has a positive impact on willingness to pay a year later inherit. To separately identify the learning and anchoring effects, we estimate a parsimonious experience-good model. Estimation results show a large, positive learning effect but no anchoring. We black then discuss the types of products and the contexts inherit for which these results may apply. PMID:25308977

  1. Lessons premier hospitals learned about implementing electronic health records.

    PubMed

    DeVore, Susan D; Figlioli, Keith

    2010-04-01

    Implementing health information technology (IT) is a major strategic objective for providers. To pinpoint considerations that tie to success, the Premier health care alliance surveyed hospitals to develop an electronic health record best-practices library. Compiled from diverse health care organizations, the library outlines considerations to support "meaningful use" in the areas of computerized physician order entry, medication management, clinical documentation, reporting of measures, privacy, information exchange, management of populations' health, and personal health records. Best practices also uncovered strategies for securing executive leadership, culture change, communication, and support for clinicians. This paper summarizes lessons from the library, providing recommendations to speed up health IT implementation. PMID:20368596

  2. Lessons premier hospitals learned about implementing electronic health records.

    PubMed

    DeVore, Susan D; Figlioli, Keith

    2010-04-01

    Implementing health information technology (IT) is a major strategic objective for providers. To pinpoint considerations that tie to success, the Premier health care alliance surveyed hospitals to develop an electronic health record best-practices library. Compiled from diverse health care organizations, the library outlines considerations to support "meaningful use" in the areas of computerized physician order entry, medication management, clinical documentation, reporting of measures, privacy, information exchange, management of populations' health, and personal health records. Best practices also uncovered strategies for securing executive leadership, culture change, communication, and support for clinicians. This paper summarizes lessons from the library, providing recommendations to speed up health IT implementation.

  3. Chapter 13: Mining Electronic Health Records in the Genomics Era

    PubMed Central

    Denny, Joshua C.

    2012-01-01

    Abstract: The combination of improved genomic analysis methods, decreasing genotyping costs, and increasing computing resources has led to an explosion of clinical genomic knowledge in the last decade. Similarly, healthcare systems are increasingly adopting robust electronic health record (EHR) systems that not only can improve health care, but also contain a vast repository of disease and treatment data that could be mined for genomic research. Indeed, institutions are creating EHR-linked DNA biobanks to enable genomic and pharmacogenomic research, using EHR data for phenotypic information. However, EHRs are designed primarily for clinical care, not research, so reuse of clinical EHR data for research purposes can be challenging. Difficulties in use of EHR data include: data availability, missing data, incorrect data, and vast quantities of unstructured narrative text data. Structured information includes billing codes, most laboratory reports, and other variables such as physiologic measurements and demographic information. Significant information, however, remains locked within EHR narrative text documents, including clinical notes and certain categories of test results, such as pathology and radiology reports. For relatively rare observations, combinations of simple free-text searches and billing codes may prove adequate when followed by manual chart review. However, to extract the large cohorts necessary for genome-wide association studies, natural language processing methods to process narrative text data may be needed. Combinations of structured and unstructured textual data can be mined to generate high-validity collections of cases and controls for a given condition. Once high-quality cases and controls are identified, EHR-derived cases can be used for genomic discovery and validation. Since EHR data includes a broad sampling of clinically-relevant phenotypic information, it may enable multiple genomic investigations upon a single set of genotyped

  4. Nurses' Experiences of an Initial and Re-Implemented Electronic Health Record Use.

    PubMed

    Lee, Ting-Ting; Chang, Chi-Ping

    2016-01-01

    The Electronic Health Record (EHR) is a key component of healthcare information systems (HISs). In EHR implementation, smooth adoption can streamline nursing activities. In order to explore the adoption process, a qualitative study design and focus group interviews were conducted 3-month post and two years after EHR system implementation (system aborted one year in between) in one hospital located in Taiwan. Content analysis was performed to analyze the interview data and six main themes were derived, in the first stage: 1) liability, work stress and anticipation for EHR, 2) slow network speed and user unfriendly design, 3) insufficient information technology/organization support; on the second stage: 4) getting used to EHR and further system requirements 5) benefits of EHR in time saving and documentation 6) unrealistic IT competence expectation and future use. It concluded that user friendly design and support by information technology and manpower backup would facilitate this adoption process. PMID:27332349

  5. 78 FR 65884 - 2014 Edition Electronic Health Record Certification Criteria: Revision to the Definition of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

    ... electronic health record (EHR) technology testing and certification. DATES: Effective date: This regulation... Computer technology, Electronic health record, Electronic information system, Electronic transactions... HUMAN SERVICES Office of the Secretary 45 CFR Part 170 RIN 0991-AB91 2014 Edition Electronic...

  6. How many schools adopt interviews during the student admission process across the health professions in the United States of America?

    PubMed

    Glazer, Greer; Startsman, Laura F; Bankston, Karen; Michaels, Julia; Danek, Jennifer C; Fair, Malika

    2016-01-01

    Health profession schools use interviews during the admissions process to identify certain non-cognitive skills that are needed for success in diverse, inter-professional settings. This study aimed to assess the use of interviews during the student admissions process across health disciplines at schools in the United States of America in 2014. The type and frequency of non-cognitive skills assessed were also evaluated. Descriptive methods were used to analyze a sample of interview rubrics collected as part of a national survey on admissions in the health professions, which surveyed 228 schools of medicine, dentistry, pharmacy, nursing, and public health. Of the 228 schools, 130 used interviews. The most desirable non-cognitive skills from 34 schools were identified as follows: communication skills (30), motivation (22), readiness for the profession (17), service (12), and problem-solving (12). Ten schools reported using the multiple mini-interview format, which may indicate potential for expanding this practice. Disparities in the use of interviewing across health professions should be verified to help schools adopt interviews during student admissions processes.

  7. Legal issues concerning electronic health information: privacy, quality, and liability.

    PubMed

    Hodge, J G; Gostin, L O; Jacobson, P D

    1999-10-20

    Personally identifiable health information about individuals and general medical information is increasingly available in electronic form in health databases and through online networks. The proliferation of electronic data within the modern health information infrastructure presents significant benefits for medical providers and patients, including enhanced patient autonomy, improved clinical treatment, advances in health research and public health surveillance, and modern security techniques. However, it also presents new legal challenges in 3 interconnected areas: privacy of identifiable health information, reliability and quality of health data, and tortbased liability. Protecting health information privacy (by giving individuals control over health data without severely restricting warranted communal uses) directly improves the quality and reliability of health data (by encouraging individual uses of health services and communal uses of data), which diminishes tort-based liabilities (by reducing instances of medical malpractice or privacy invasions through improvements in the delivery of health care services resulting in part from better quality and reliability of clinical and research data). Following an analysis of the interconnectivity of these 3 areas and discussing existing and proposed health information privacy laws, recommendations for legal reform concerning health information privacy are presented. These include (1) recognizing identifiable health information as highly sensitive, (2) providing privacy safeguards based on fair information practices, (3) empowering patients with information and rights to consent to disclosure (4) limiting disclosures of health data absent consent, (5) incorporating industry-wide security protections, (6) establishing a national data protection authority, and (7) providing a national minimal level of privacy protections. PMID:10535438

  8. Legal issues concerning electronic health information: privacy, quality, and liability.

    PubMed

    Hodge, J G; Gostin, L O; Jacobson, P D

    1999-10-20

    Personally identifiable health information about individuals and general medical information is increasingly available in electronic form in health databases and through online networks. The proliferation of electronic data within the modern health information infrastructure presents significant benefits for medical providers and patients, including enhanced patient autonomy, improved clinical treatment, advances in health research and public health surveillance, and modern security techniques. However, it also presents new legal challenges in 3 interconnected areas: privacy of identifiable health information, reliability and quality of health data, and tortbased liability. Protecting health information privacy (by giving individuals control over health data without severely restricting warranted communal uses) directly improves the quality and reliability of health data (by encouraging individual uses of health services and communal uses of data), which diminishes tort-based liabilities (by reducing instances of medical malpractice or privacy invasions through improvements in the delivery of health care services resulting in part from better quality and reliability of clinical and research data). Following an analysis of the interconnectivity of these 3 areas and discussing existing and proposed health information privacy laws, recommendations for legal reform concerning health information privacy are presented. These include (1) recognizing identifiable health information as highly sensitive, (2) providing privacy safeguards based on fair information practices, (3) empowering patients with information and rights to consent to disclosure (4) limiting disclosures of health data absent consent, (5) incorporating industry-wide security protections, (6) establishing a national data protection authority, and (7) providing a national minimal level of privacy protections.

  9. Reliability and validity of the American Hospital Association's national longitudinal survey of health information technology adoption

    PubMed Central

    Everson, Jordan; Lee, Shoou-Yih D; Friedman, Charles P

    2014-01-01

    Objective To evaluate the internal consistency, construct validity, and criterion validity of a battery of items measuring information technology (IT) adoption, included in the American Hospital Association (AHA) IT Supplement Survey. Methods We analyzed the 2012 release of the AHA IT Supplement Survey. We performed reliability analysis using Cronbach's α and part-whole correlations, construct validity analysis using principal component analysis (PCA), and criterion validity analysis by assessing the items’ sensitivity and specificity of predicting attestation to Medicare Meaningful Use (MU). Results Twenty-eight items of the 31-item instrument and five of six functionality subcategories defined by the AHA all produced reliable scales (α’s between 0.833 and 0.958). PCA mostly confirmed the AHA's categorization of functionalities; however, some items loaded only weakly onto the factor most associated with their survey category, and one category loaded onto two separate factors. The battery of items was a valid predictor of attestation to MU, producing a sensitivity of 0.82 and a specificity of 0.72. Discussion The battery of items performed well on most indices of reliability and validity. However, they lack some components of ideal survey design, leaving open the possibility that respondents are not responding independently to each item in the survey. Despite measuring only a portion of the objectives required for attestation to MU, the items are a moderately sensitive and specific predictor of attestation. Conclusions The analyzed instrument exhibits satisfactory reliability and validity. PMID:24623194

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

    PubMed

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

    2016-06-01

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

  11. Analysis of Service-learning activities adopted in health courses of Federal University of Bahia.

    PubMed

    Baldoino, Aline Silva; Veras, Renata Meira

    2016-06-01

    is study aimed to raise and discuss the data about the integration of health courses teaching and service activities o ered at the Federal University of Bahia (UFBA), pre- senting scenarios practices and major di culties existing in the relationship between the university and the services of health. is was a qualitative study of descriptive explo- ratory character, using a questionnaire as a research tool applied to the coordinators of selected health courses. e selection was by reading the political pedagogical project, the following courses were selected: nursing, physical therapy, speech therapy, medicine, nu- trition, dentistry and public health. e results indicated eight types of teaching-service integration activities, 57 scenarios of practice and the main di culties. It was concluded that these courses are sticking to changes in academic training in health, in view of the large number of basic health units in the teaching service process. us, it emphasizes that the UFBA includes activities in health care that enable the integration-education in the higher education process, although there are some di culties in this relationship indicated by the coordinators. Esse estudo teve como objetivo levantar e discutir os dados acerca das atividades de integração ensino-serviço de cursos de saúde oferecidos na Universidade Federal da Bahia (UFBA), apresentando os cenários de práticas e as principais di culdades existentes na relação entre a uni- versidadeeosserviçosdesaúde.Tratou-sedeumapesquisaqualitativa,decaráterdescritivoexploratório,utilizando-seumquestionáriocomo instrumento de investigação aplicado aos coordenadores dos cursos de saúde selecionados. A seleção foi mediante a leitura do projeto político pedagógico, sendo selecionados os seguintes cursos: enfermagem, sioterapia, fonoaudiologia, medicina, nutrição, odontologia e saúde coletiva. Os resultados indicaram 8 tipos de atividades de integração ensino-serviço, 57 cenários de pr

  12. Analysis of Service-learning activities adopted in health courses of Federal University of Bahia.

    PubMed

    Baldoino, Aline Silva; Veras, Renata Meira

    2016-06-01

    is study aimed to raise and discuss the data about the integration of health courses teaching and service activities o ered at the Federal University of Bahia (UFBA), pre- senting scenarios practices and major di culties existing in the relationship between the university and the services of health. is was a qualitative study of descriptive explo- ratory character, using a questionnaire as a research tool applied to the coordinators of selected health courses. e selection was by reading the political pedagogical project, the following courses were selected: nursing, physical therapy, speech therapy, medicine, nu- trition, dentistry and public health. e results indicated eight types of teaching-service integration activities, 57 scenarios of practice and the main di culties. It was concluded that these courses are sticking to changes in academic training in health, in view of the large number of basic health units in the teaching service process. us, it emphasizes that the UFBA includes activities in health care that enable the integration-education in the higher education process, although there are some di culties in this relationship indicated by the coordinators. Esse estudo teve como objetivo levantar e discutir os dados acerca das atividades de integração ensino-serviço de cursos de saúde oferecidos na Universidade Federal da Bahia (UFBA), apresentando os cenários de práticas e as principais di culdades existentes na relação entre a uni- versidadeeosserviçosdesaúde.Tratou-sedeumapesquisaqualitativa,decaráterdescritivoexploratório,utilizando-seumquestionáriocomo instrumento de investigação aplicado aos coordenadores dos cursos de saúde selecionados. A seleção foi mediante a leitura do projeto político pedagógico, sendo selecionados os seguintes cursos: enfermagem, sioterapia, fonoaudiologia, medicina, nutrição, odontologia e saúde coletiva. Os resultados indicaram 8 tipos de atividades de integração ensino-serviço, 57 cenários de pr

  13. Characterizing Participants in the ClinSeq Genome Sequencing Cohort as Early Adopters of a New Health Technology.

    PubMed

    Lewis, Katie L; Han, Paul K J; Hooker, Gillian W; Klein, William M P; Biesecker, Leslie G; Biesecker, Barbara B

    2015-01-01

    Genome sequencing is a novel clinical tool that has the potential to identify genetic origins of disease. However, the complexities of this new technology are significant and little is known about its integration into clinical care, and its potential adoption by patients. Expectations of its promise for personalized medicine are high and it is important to properly match expectations to the realities of the test. The NIH ClinSeq cohort study pilots the integration of genome sequencing into clinical research and care to assess the technical, medical and socio-behavioral aspects of implementing this technology. Over 950 adults ages 45-65 have been enrolled and clinically phenotyped. As an initial study, we describe the personality traits of ClinSeq participants, and explore how these traits compare to those that characterize early adopters of other new technologies. Our analysis was conducted on responses from 630 members of the cohort who completed a baseline survey on health cognitions, affect, health-related behaviors and personality traits, prior to receipt of any genome sequencing results. The majority of participants were white (90.5%), had at least a college degree (86.5%), and had at least one biological child (74.6%). Members of this ClinSeq sample were found to be high in dispositional optimism and resilience. Their high SES paralleled that of other early adopters of new technology. These attributes may contribute to participants' expectations for favorable outcomes and willingness to take higher risks when compared to the general population. These characteristics may distinguish those who are most likely to pursue genome sequencing and be indicative of their psychological resources to manage returned results.

  14. Characterizing Participants in the ClinSeq Genome Sequencing Cohort as Early Adopters of a New Health Technology

    PubMed Central

    Lewis, Katie L.; Han, Paul K. J.; Hooker, Gillian W.; Klein, William M. P.; Biesecker, Leslie G.; Biesecker, Barbara B.

    2015-01-01

    Genome sequencing is a novel clinical tool that has the potential to identify genetic origins of disease. However, the complexities of this new technology are significant and little is known about its integration into clinical care, and its potential adoption by patients. Expectations of its promise for personalized medicine are high and it is important to properly match expectations to the realities of the test. The NIH ClinSeq cohort study pilots the integration of genome sequencing into clinical research and care to assess the technical, medical and socio-behavioral aspects of implementing this technology. Over 950 adults ages 45-65 have been enrolled and clinically phenotyped. As an initial study, we describe the personality traits of ClinSeq participants, and explore how these traits compare to those that characterize early adopters of other new technologies. Our analysis was conducted on responses from 630 members of the cohort who completed a baseline survey on health cognitions, affect, health-related behaviors and personality traits, prior to receipt of any genome sequencing results. The majority of participants were white (90.5%), had at least a college degree (86.5%), and had at least one biological child (74.6%). Members of this ClinSeq sample were found to be high in dispositional optimism and resilience. Their high SES paralleled that of other early adopters of new technology. These attributes may contribute to participants’ expectations for favorable outcomes and willingness to take higher risks when compared to the general population. These characteristics may distinguish those who are most likely to pursue genome sequencing and be indicative of their psychological resources to manage returned results. PMID:26186621

  15. Meeting user needs in national healthcare systems: lessons from early adopter community pharmacists using the electronic prescriptions service

    PubMed Central

    2014-01-01

    Background The Electronic Prescription Service release Two (EPS2) is a new national healthcare information and communication technology in England that aims to deliver effective prescription writing, dispensing and reimbursement service to benefit patients. The aim of the study was to explore initial user experiences of Community Pharmacists (CPs) using EPS2. Methods We conducted nonparticipant observations and interviews in eight EPS2 early adopter community pharmacies classified as ‘first-of-type’ in midlands and northern regions in England. We interviewed eight pharmacists and two dispensers in addition to 56 hours recorded nonparticipant observations as field notes. Line-by-line coding and thematic analysis was conducted on the interview transcripts and field notes. Results CPs faced two types of challenge. The first was to do with missing electronic prescriptions. This was sometimes very disrupting to work practice, but pharmacists considered it a temporary issue resolvable with minor modifications to the system and user familiarity. The second was to do with long term design-specific issues. Pharmacists could only overcome these by using the system in ways not intended by the developers. Some felt that these issues would not exist had ‘real’ users been involved in the initial development. The issues were: 1) printing out electronic prescriptions (tokens) to dispense from for safe dispensing practices and to free up monitors for other uses, 2) logging all dispensing activities with one user’s Smartcard for convenience and use all human resources in the pharmacy, and, 3) problematic interface causing issues with endorsing prescriptions and claiming reimbursements. Conclusions We question if these unintended uses and barriers would have occurred had a more rigorous user-centric principles been applied at the earlier stages of design and implementation of EPS. We conclude that, since modification can occur at the evaluation stage, there is still scope

  16. Determinants of the intention of elementary school nurses to adopt a redefined role in health promotion at school

    PubMed Central

    2010-01-01

    Background The quest for greater efficiency in the provision of primary healthcare services and the implementation of a "health-promoting school" approach encourage the optimal redefinition of the role of school nurses. School nurses are viewed as professionals who might be significant actors in the promotion of youth health. The aim of this study was to identify the determinants of the intention of elementary school nurses to adopt a new health-promotion role as a strategic option for the health-promoting school. Methods This study was based on an extended version of the theory of planned behaviour (TPB). A total of 251 respondents (response rate of 70%) from 42 school health programs across the Province of Québec completed a mail survey regarding their intention to adopt the proposed health-promotion role. Multiple hierarchical linear regression analyses were performed to assess the relationship between key independent variables and intention. A discriminant analysis of the beliefs was performed to identify the main targets of action. Results A total of 73% of respondents expressed a positive intention to accept to play the proposed role. The main predictors were perceived behavioural control (β = 0.36), moral norm (β = 0.27), attitude (β = 0.24), and subjective norm (β = 0.21) (ps < .0001), explaining 83% of the variance. The underlying beliefs distinguishing nurses who had a high intention from those who had a low intention referred to their feelings of being valued, their capacity to overcome the nursing shortage, the approval of the school nurses' community and parents of the students, their leadership skills, and their gaining of a better understanding of school needs. Conclusions Results suggest that leadership is a skill that should be addressed to increase the ability of school nurses to assume the proposed role. Findings also indicate that public health administrators need to ensure adequate nurse staffing in the schools in order to increase the

  17. Assessing patients' health behaviours. Essential steps for motivating patients to adopt and maintain behaviours conducive to oral health.

    PubMed

    Freeman, Ruth; Ismail, Amid

    2009-01-01

    This chapter provides a summary of various approaches to behaviour change in oral health. The current research evidence does not support the practice of giving 'instructions' or 'advice' to patients as a means of modifying their attitudes or changing their health behaviours. A number of explanatory models are described which address both the complexity and the factors that influence and predict an individual's health behaviour. A practical guide of what should be assessed and professional assumptions which may be made to assist patients change and maintain their health behaviours are provided. The potential for difficulty during this assessment period is raised since this awareness will allow for flexibility when negotiating with patients to help them develop strategies to modify, change and maintain their health behaviours. Thus, the last part of the chapter describes new approaches that rely on multiple models that focus on patients' or recipients' beliefs, desired goals and readiness to change which are preferable to the traditional patient education approaches in dentistry. PMID:19494679

  18. Phased implementation of electronic health records through an office of clinical transformation.

    PubMed

    Banas, Colin A; Erskine, Alistair R; Sun, Shumei; Retchin, Sheldon M

    2011-01-01

    Evidence suggests that when carefully implemented, health information technologies (HIT) have a positive impact on behavior, as well as operational, process, and clinical outcomes. Recent economic stimulus initiatives have prompted unprecedented federal investment in HIT. Despite strong interest from the healthcare delivery community to achieve 'meaningful use' of HIT within a relatively short time frame, few best-practice implementation methodologies have been described. Herein we outline HIT implementation strategies at an academic health center with an office of clinical transformation. Seven percent of the medical center's information technology budget was dedicated to the Office of Clinical Transformation, and successful conversion of 1491 physicians to electronic-based documentation was accomplished. This paper outlines the process re-design, end-user adoption, and practice transformation strategies that resulted in a 99.7% adoption rate within 6 months of the introduction of digital documentation.

  19. How user diversity and country of origin impact the readiness to adopt E-health technologies: an intercultural comparison.

    PubMed

    Wilkowsk, Wiktoria; Ziefle, Martina; Alagöz, Firat

    2012-01-01

    In recent years, due to the demographical change and the resulting overload of healthcare systems, there has been an increasing interest focusing on the global proliferation of assistive medical technologies (=E-health) in home environments. The present study examines how users' diversity influences the readiness to adopt novel medical technologies, comparing users' attitudes in terms of perceived advantages and disadvantages in three technically and culturally different countries: Germany, Poland and Turkey. This investigation also intended to verify if acceptance of information and communication technologies is associated with the sensitive acceptance of E-health. Results revealed overall a considerably higher motivation to use medical technology compared to perceived barriers, with Polish users more willing to use E-health, higher than German or Turkish ones. Older participants showed a highly positive attitude, comparable to young and middle-aged respondents' receptiveness, differing from the latter in terms of greater appreciation of the advantage of higher independency when being supported by medical technology. With respect to gender, woman showed higher motivation to use E-health technology than men, although utilization barriers were not gendered. Following these results, an unconditional transfer of acceptance from information and communication to medical technology is not justified.

  20. How user diversity and country of origin impact the readiness to adopt E-health technologies: an intercultural comparison.

    PubMed

    Wilkowsk, Wiktoria; Ziefle, Martina; Alagöz, Firat

    2012-01-01

    In recent years, due to the demographical change and the resulting overload of healthcare systems, there has been an increasing interest focusing on the global proliferation of assistive medical technologies (=E-health) in home environments. The present study examines how users' diversity influences the readiness to adopt novel medical technologies, comparing users' attitudes in terms of perceived advantages and disadvantages in three technically and culturally different countries: Germany, Poland and Turkey. This investigation also intended to verify if acceptance of information and communication technologies is associated with the sensitive acceptance of E-health. Results revealed overall a considerably higher motivation to use medical technology compared to perceived barriers, with Polish users more willing to use E-health, higher than German or Turkish ones. Older participants showed a highly positive attitude, comparable to young and middle-aged respondents' receptiveness, differing from the latter in terms of greater appreciation of the advantage of higher independency when being supported by medical technology. With respect to gender, woman showed higher motivation to use E-health technology than men, although utilization barriers were not gendered. Following these results, an unconditional transfer of acceptance from information and communication to medical technology is not justified. PMID:22317022

  1. Conflict and compromise in public health policy: analysis of changes made to five competitive food legislative proposals prior to adoption.

    PubMed

    Dinour, Lauren M

    2015-04-01

    Competitive foods in schools have historically been scrutinized for their ubiquity and poor nutritional quality, leading many states to enact legislation limiting the availability and accessibility of these items. Evaluations of these policy approaches show their promise in improving the healthfulness of school food environments, considered an important strategy for reducing childhood obesity. Yet little is known about the decision-making processes by which such legislation is formed and adopted. Using a comparative case study design, this study describes and analyzes the policy formation processes surrounding five state-level competitive food bills introduced in 2009-2010. Data for each case were drawn from multiple key informant interviews and document reviews. Case studies were conducted, analyzed, and written independently using a standard protocol and were subsequently compared for recurring and unique themes. Abbreviated case studies and summary tables are provided. Results indicate that bill cost is a major barrier to achieving strong, health-promoting policy change. Additionally, findings reveal that supporters of stronger competitive food policies often concede to changes that weaken a bill in order to neutralize opposition and achieve stakeholder buy-in. These challenges suggest that continued research on the development, implementation, and evaluation of public health policies can contribute to the advancement of new strategies for effective health promotion.

  2. Disparities in Primary Care EHR Adoption Rates

    PubMed Central

    Mack, Dominic; Zhang, Shun; Douglas, Megan; Sow, Charles; Strothers, Harry; Rust, George

    2016-01-01

    This study evaluates electronic health record (EHR) adoption by primary care providers in Georgia to assess adoption disparities according to practice size and type, payer mix, and community characteristics. Frequency variances of EHR “Go Live” status were estimated. Odds ratios were calculated by univariate and multivariate logistic regression models. Large practices and community health centers (CHCs) were more likely to Go Live (>80% EHR adoption) than rural health clinics and other underserved settings (53%). A significantly lower proportion (68.9%) of Medicaid predominant providers had achieved Go Live status and had a 47% higher risk of not achieving Go Live status than private insurance predominant practices. Disparities in EHR adoption rates may exacerbate existing disparities in health outcomes of patients served by these practices. Targeted support such as that provided to CHCs would level the playing field for practices now at a disadvantage. PMID:27587942

  3. Platform links clinical data with electronic health records

    Cancer.gov

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

  4. Electronic Health Records Place 1st at Indy 500

    MedlinePlus

    ... Electronic Health Records were instantly, securely available to medical personnel at the world-famous Indy 500 motor race. ... data-sharing system that allows physicians and emergency medical personnel access to individual patient records. It is made ...

  5. A Formative and Summative Evaluation of an Electronic Health Record in Community Nursing

    PubMed Central

    Doran, Diane; Bloomberg, Lawrence S.; Reid-Haughian, Cheryl; Cafazzo, Joseph

    2012-01-01

    Implementation of an electronic health record (EHR) system is generally believed to improve the quality of patient care. However due to the variability of systems and users, there is little agreement on successful implementation. The purpose of this research is to evaluate the implementation of a BlackBerry hosted application enabling wireless documentation and access to electronic decision support resources in one home care agency in Ontario. Through mixed-methods including surveys, corporate data collection and interviews, this study investigates nurses’ perceptions of barriers and facilitators to adoption of the electronic clinical information system. Early results highlight usability, organizational culture, evidence-based practice, and factors influencing nurses’ adaptation of this electronic clinical information system. PMID:24199063

  6. A formative and summative evaluation of an electronic health record in community nursing.

    PubMed

    Doran, Diane; Bloomberg, Lawrence S; Reid-Haughian, Cheryl; Cafazzo, Joseph

    2012-01-01

    Implementation of an electronic health record (EHR) system is generally believed to improve the quality of patient care. However due to the variability of systems and users, there is little agreement on successful implementation. The purpose of this research is to evaluate the implementation of a BlackBerry hosted application enabling wireless documentation and access to electronic decision support resources in one home care agency in Ontario. Through mixed-methods including surveys, corporate data collection and interviews, this study investigates nurses' perceptions of barriers and facilitators to adoption of the electronic clinical information system. Early results highlight usability, organizational culture, evidence-based practice, and factors influencing nurses' adaptation of this electronic clinical information system. PMID:24199063

  7. Adoption and sustainability of decision support for patients facing health decisions: an implementation case study in nursing

    PubMed Central

    Stacey, Dawn; Pomey, Marie-Pascale; O'Connor, Annette M; Graham, Ian D

    2006-01-01

    Background Effective interventions prepare patients for making values-sensitive health decisions by helping them become informed and clarifying their values for each of the options. However, patient decision support interventions have not been widely implemented and little is known about effective models for delivering them to patients. The purpose of this study was to describe call centre nurses' adoption of a decision support protocol into practice following exposure to an implementation intervention and to identify factors influencing sustainable nursing practice changes. Methods Exploratory case study at a Canadian province-wide call centre guided by the Ottawa Model of Research Use. Data sources included a survey of nurses who participated in an implementation intervention (n = 31), 2 focus groups with nurses, interviews with 4 administrators, and a document review. Results Twenty-five of 31 nurses responded to the survey measuring adoption of decision support in practice. Of the 25 nurses, 11 had used the decision support protocol in their practice within one month of the intervention. Twenty-two of the 25 intended to use it within the next three months. Although some nurses found it challenging to begin using the protocol, most nurses reported that it: a) helped them recognize callers needing decision support; b) changed their approach to handling these calls; and c) was a positive enhancement to their practice. Strategies identified to promote sustainability of practice changes included integration of the decision support protocol in the call centre database, streamlining the patient decision aids for easier use via telephone, clarifying the administrative direction for the call centre's program, creating a call length guideline specific for these calls, incorporating decision support training in the staff development plan, and informing the public of this enhanced service. Conclusion Although most nurses adopted the decision support protocol for coaching

  8. Adoption of Health Information Exchange by Emergency Physicians at Three Urban Academic Medical Centers

    PubMed Central

    Genes, N.; Shapiro, J.; Vaidya, S.; Kuperman, G.

    2011-01-01

    Objectives Emergency physicians are trained to make decisions quickly and with limited patient information. Health Information Exchange (HIE) has the potential to improve emergency care by bringing relevant patient data from non-affiliated organizations to the bedside. NYCLIX (New York CLinical Information eXchange) offers HIE functionality among multiple New York metropolitan area provider organizations and has pilot users in several member emergency departments (EDs). Methods We conducted semi-structured interviews at three participating EDs with emergency physicians trained to use NYCLIX. Among “users” with > 1 login, responses to questions regarding typical usage scenarios, successful retrieval of data, and areas for improving the interface were recorded. Among “non-users” with ≤1 login, questions about NYCLIX accessibility and utility were asked. Both groups were asked to recall items from prior training regarding data sources and availability. Results Eighteen NYCLIX pilot users, all board certified emergency physicians, were interviewed. Of the 14 physicians with more than one login ,half estimated successful retrieval of HIE data affecting patient care. Four non-users (one login or less) cited forgotten login information as a major reason for non-use. Though both groups made errors, users were more likely to recall true NYCLIX member sites and data elements than non-users. Improvements suggested as likely to facilitate usage included a single automated login to both the ED information system (EDIS) and HIE, and automatic notification of HIE data availability in the EDIS All respondents reported satisfaction with their training. Conclusions Integrating HIE into existing ED workflows remains a challenge, though a substantial fraction of users report changes in management based on HIE data. Though interviewees believed their training was adequate, significant errors in their understanding of available NYCLIX data elements and participating sites

  9. How did international agencies perceive the avian influenza problem? The adoption and manufacture of the 'One World, One Health' framework.

    PubMed

    Chien, Yu-Ju

    2013-02-01

    Over the past few years, a 'One World, One Health' (OWOH) policy framework has become the guiding principle for international responses to avian influenza and other zoonotic infectious diseases. Several specialised inter-governmental agencies, including the World Health Organization, the Food and Agricultural Organization and World Organization for Animal Health, jointly endorsed and promoted this framework. This article attempts to explain why international agencies advocated OWOH despite its vagueness. By examining how these international agencies gradually reframed avian flu problems, this article illustrates the crucial roles of international agencies in constructing disease knowledge and relevant policy responses. It shows that the three agencies adopted an all-inclusive approach to reduce conflicts, defend their legitimacy, and facilitate commitment for collaboration. Not only has this new framework reduced tensions between agencies, it has also reshaped the interests and interactions of other global actors. The case thus illustrates how these organisational actors actively manufacture new cognitive frames and policy regimes that advance their own legitimacy and influence. PMID:23095003

  10. School Nurse Role in Electronic School Health Records. Position Statement

    ERIC Educational Resources Information Center

    Hiltz, Cynthia; Johnson, Katie; Lechtenberg, Julia Rae; Maughan, Erin; Trefry, Sharonlee

    2014-01-01

    It is the position of the National Association of School Nurses (NASN) that Electronic Health Records (EHRs) are essential for the registered professional school nurse (hereinafter referred to as school nurse) to provide efficient and effective care in the school and monitor the health of the entire student population. It is also the position of…

  11. A decision technology system for health care electronic commerce.

    PubMed

    Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

    1999-08-01

    Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice. PMID:10539421

  12. A decision technology system for health care electronic commerce.

    PubMed

    Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

    1999-08-01

    Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

  13. 45 CFR 170.210 - Standards for health information technology to protect electronic health information created...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... operations, as these terms are defined at 45 CFR 164.501. (e) Record actions related to electronic health... algorithm identified by the National Institute of Standards and Technology (NIST) as an approved security...) Verification that electronic health information has not been altered in transit. Standard. A hashing...

  14. Health and Environmental Hazards of Electronic Waste in India.

    PubMed

    Borthakur, Anwesha

    2016-04-01

    Technological waste in the form of electronic waste (e-waste) is a threat to all countries. E-waste impacts health and the environment by entering the food chain in the form of chemical toxicants and exposing the population to deleterious chemicals, mainly in the form of polycyclic aromatic hydrocarbons and persistent organic pollutants. This special report tries to trace the environmental and health implications of e-waste in India. The author concludes that detrimental health and environmental consequences are associated with e-waste and the challenge lies in producing affordable electronics with minimum chemical toxicants.

  15. Health and Environmental Hazards of Electronic Waste in India.

    PubMed

    Borthakur, Anwesha

    2016-04-01

    Technological waste in the form of electronic waste (e-waste) is a threat to all countries. E-waste impacts health and the environment by entering the food chain in the form of chemical toxicants and exposing the population to deleterious chemicals, mainly in the form of polycyclic aromatic hydrocarbons and persistent organic pollutants. This special report tries to trace the environmental and health implications of e-waste in India. The author concludes that detrimental health and environmental consequences are associated with e-waste and the challenge lies in producing affordable electronics with minimum chemical toxicants. PMID:27188068

  16. Possibilities and Implications of Using the ICF and Other Vocabulary Standards in Electronic Health Records.

    PubMed

    Vreeman, Daniel J; Richoz, Christophe

    2015-12-01

    There is now widespread recognition of the powerful potential of electronic health record (EHR) systems to improve the health-care delivery system. The benefits of EHRs grow even larger when the health data within their purview are seamlessly shared, aggregated and processed across different providers, settings and institutions. Yet, the plethora of idiosyncratic conventions for identifying the same clinical content in different information systems is a fundamental barrier to fully leveraging the potential of EHRs. Only by adopting vocabulary standards that provide the lingua franca across these local dialects can computers efficiently move, aggregate and use health data for decision support, outcomes management, quality reporting, research and many other purposes. In this regard, the International Classification of Functioning, Disability, and Health (ICF) is an important standard for physiotherapists because it provides a framework and standard language for describing health and health-related states. However, physiotherapists and other health-care professionals capture a wide range of data such as patient histories, clinical findings, tests and measurements, procedures, and so on, for which other vocabulary standards such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature Of Medicine Clinical Terms are crucial for interoperable communication between different electronic systems. In this paper, we describe how the ICF and other internationally accepted vocabulary standards could advance physiotherapy practise and research by enabling data sharing and reuse by EHRs. We highlight how these different vocabulary standards fit together within a comprehensive record system, and how EHRs can make use of them, with a particular focus on enhancing decision-making. By incorporating the ICF and other internationally accepted vocabulary standards into our clinical information systems, physiotherapists will be able to leverage the potent

  17. Electronic Personal Health Records for Childhood Cancer Survivors: An Exploratory Study

    PubMed Central

    Carvalho, Priscilla; Southward, Matthew; Schmidt, Mary Lou; Jabine, Leslie N.; Stolley, Melinda R.; Gerber, Ben S.

    2014-01-01

    Purpose: Childhood cancer survivors have complex healthcare needs that may be effectively communicated using electronic personal health records. This study explores the knowledge, interest, and attitudes of a sample of survivors and some of their caregivers towards electronic personal health records (ePHRs). Methods: This descriptive study was conducted in a pediatric hematology-oncology clinic and associated survivorship clinic with a convenience sample of caregivers of survivors who were <14 years old and survivors ≥14 years old along with their caregivers when present. A semi-structured interview was conducted with survivors and some caregivers to understand their knowledge, interest, and attitudes towards adoption of ePHRs. Results: Interviews were completed with 11 caregivers of young survivors, four survivors alone, and five survivor–caregiver dyads. Survivors ranged in age at diagnosis from 1 to 17 years old. Among the ethnically diverse sample, approximately half of the nine survivors and 25% of 16 caregivers reported having some knowledge of ePHRs. Eighty-nine percent (8/9) of the survivors and 81% (13/16) of the caregivers reported that they were somewhat or very comfortable using the internet. All nine survivors and 75% of caregivers were interested in the adoption of ePHRs. Data security and privacy were the primary concerns expressed. Conclusions: Interest in adoption of ePHRs to manage cancer survivorship-related health information was high. Most felt that the privacy and security concerns would not prevent adoption. Additional research is needed on larger and more representative samples of survivors to understand what types of support and education are needed to effectively implement ePHRs. PMID:25276495

  18. Electronic Personal Health Records for Childhood Cancer Survivors: An Exploratory Study.

    PubMed

    Sharp, Lisa K; Carvalho, Priscilla; Southward, Matthew; Schmidt, Mary Lou; Jabine, Leslie N; Stolley, Melinda R; Gerber, Ben S

    2014-09-01

    Purpose: Childhood cancer survivors have complex healthcare needs that may be effectively communicated using electronic personal health records. This study explores the knowledge, interest, and attitudes of a sample of survivors and some of their caregivers towards electronic personal health records (ePHRs). Methods: This descriptive study was conducted in a pediatric hematology-oncology clinic and associated survivorship clinic with a convenience sample of caregivers of survivors who were <14 years old and survivors ≥14 years old along with their caregivers when present. A semi-structured interview was conducted with survivors and some caregivers to understand their knowledge, interest, and attitudes towards adoption of ePHRs. Results: Interviews were completed with 11 caregivers of young survivors, four survivors alone, and five survivor-caregiver dyads. Survivors ranged in age at diagnosis from 1 to 17 years old. Among the ethnically diverse sample, approximately half of the nine survivors and 25% of 16 caregivers reported having some knowledge of ePHRs. Eighty-nine percent (8/9) of the survivors and 81% (13/16) of the caregivers reported that they were somewhat or very comfortable using the internet. All nine survivors and 75% of caregivers were interested in the adoption of ePHRs. Data security and privacy were the primary concerns expressed. Conclusions: Interest in adoption of ePHRs to manage cancer survivorship-related health information was high. Most felt that the privacy and security concerns would not prevent adoption. Additional research is needed on larger and more representative samples of survivors to understand what types of support and education are needed to effectively implement ePHRs.

  19. Is Canada ready for patient accessible electronic health records? A national scan

    PubMed Central

    Urowitz, Sara; Wiljer, David; Apatu, Emma; Eysenbach, Gunther; DeLenardo, Claudette; Harth, Tamara; Pai, Howard; Leonard, Kevin J

    2008-01-01

    Background Access to personal health information through the electronic health record (EHR) is an innovative means to enable people to be active participants in their own health care. Currently this is not an available option for consumers of health. The absence of a key technology, the EHR, is a significant obstacle to providing patient accessible electronic records. To assess the readiness for the implementation and adoption of EHRs in Canada, a national scan was conducted to determine organizational readiness and willingness for patient accessible electronic records. Methods A survey was conducted of Chief Executive Officers (CEOs) of Canadian public and acute care hospitals. Results Two hundred thirteen emails were sent to CEOs of Canadian general and acute care hospitals, with a 39% response rate. Over half (54.2%) of hospitals had some sort of EHR, but few had a record that was predominately electronic. Financial resources were identified as the most important barrier to providing patients access to their EHR and there was a divergence in perceptions from healthcare providers and what they thought patients would want in terms of access to the EHR, with providers being less willing to provide access and patients desire for greater access to the full record. Conclusion As the use of EHRs becomes more commonplace, organizations should explore the possibility of responding to patient needs for clinical information by providing access to their EHR. The best way to achieve this is still being debated. PMID:18652695

  20. Big data and the electronic health record.

    PubMed

    Peters, Steve G; Buntrock, James D

    2014-01-01

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

  1. Factors influencing nursing students' acceptance of electronic health records for nursing education (EHRNE) software program.

    PubMed

    Kowitlawakul, Yanika; Chan, Sally Wai Chi; Pulcini, Joyce; Wang, Wenru

    2015-01-01

    The Institute of Medicine (IOM) and the Health Information Technology Act (2009) in America had recommended that electronic health records (EHRs) should be fully adopted by 2014. This has urged educational institutions to prepare healthcare professionals to be competent in using electronic health records (EHRs) while they are in schools. To equip nursing students with competency in using EHRs, an electronic health record for nursing education (EHRNE) has been developed and integrated it into nursing curricula. The purposes of the study were to investigate the factors influencing nursing students' acceptance of the EHRs in nursing education using the extended Technology Acceptance Model with self-efficacy as a conceptual framework. The study is a descriptive study design using self-reported questionnaires with 212 student participants. The IBM SPSS and AMOS 22.0 were used to analyze the data. The results showed that attitude toward using the EHRNE was the most influential factor on students' acceptance. The preliminary findings suggested that to enhance the students' acceptance of the EHRNE, cultivation of a positive attitude toward using this EHR as well as increasing the perceived usefulness is very important. Also, the study's framework could be used in guiding learning health informatics and be applied to nursing students.

  2. Electronic health records: a new tool to combat chronic kidney disease?

    PubMed Central

    Navaneethan, Sankar D.; Jolly, Stacey E.; Sharp, John; Jain, Anil; Schold, Jesse D.; Schreiber, Martin J.; Nally, Joseph V.

    2013-01-01

    Electronic health records (EHRs) were first developed in the 1960s as clinical information systems for document storage and retrieval. Adoption of EHRs has increased in the developed world and is increasing in developing countries. Studies have shown that quality of patient care is improved among health centers with EHRs. In this article, we review the structure and function of EHRs along with an examination of its potential application in CKD care and research. Well-designed patient registries using EHRs data allow for improved aggregation of patient data for quality improvement and to facilitate clinical research. Preliminary data from the United States and other countries have demonstrated that CKD care might improve with use of EHRs-based programs. We recently developed a CKD registry derived from EHRs data at our institution and complimented the registry with other patient details from the United States Renal Data System and the Social Security Death Index. This registry allows us to conduct a EHRs-based clinical trial that examines whether empowering patients with a personal health record or patient navigators improves CKD care, along with identifying participants for other clinical trials and conducting health services research. EHRs use have shown promising results in some settings, but not in others, perhaps attributed to the differences in EHRs adoption rates and varying functionality. Thus, future studies should explore the optimal methods of using EHRs to improve CKD care and research at the individual patient level, health system and population levels. PMID:23320972

  3. Electronic Health Data for Postmarket Surveillance: A Vision Not Realized.

    PubMed

    Moore, Thomas J; Furberg, Curt D

    2015-07-01

    What has been learned about electronic health data as a primary data source for regulatory decisions regarding the harms of drugs? Observational studies with electronic health data for postmarket risk assessment can now be conducted in Europe and the US in patient populations numbering in the tens of millions compared with a few hundred patients in a typical clinical trial. With standard protocols, results can be obtained in a few months; however, extensive research published by scores of investigators has illuminated the many obstacles that prevent obtaining robust, reproducible results that are reliable enough to be a primary source for drug safety decisions involving the health and safety of millions of patients. The most widely used terminology for coding patient interactions with medical providers for payment has proved ill-suited to identifying the adverse effects of drugs. Directly conflicting results were reported in otherwise similar patient health databases, even using identical event definitions and research methods. Evaluation of some accepted statistical methods revealed systematic bias, while others appeared to be unreliable. When electronic health data studies detected no drug risk, there were no robust and accepted standards to judge whether the drug was unlikely to cause the adverse effect or whether the study was incapable of detecting it. Substantial investment and careful thinking is needed to improve the reliability of risk assessments based on electronic health data, and current limitations need to be fully understood. PMID:26025018

  4. [Electronic health strategies in The Americas: current situation and perspectives].

    PubMed

    D Agostino, Marcelo

    2015-01-01

    The main objective of the Strategy and Plan of Action on eHealth (2012-2017) is to contribute to sustainable development of health systems of member states. Its adoption aims to improve quality and access to health services through the use of information and communication technologies (ICT), the implementation of digital literacy programs and access to quality information to advance towards more informed, equitable, competitive and democratic societies. PAHO/WHO considers that in society, free and equal access to health information should be a fundamental right of individuals. Access to information, knowledge sharing and use of information and communication technology in the health sector continues to grow and is driving significant changes in the way people interact with health services and among themselves in social networks and through the use of mobile devices (mHealth). This hyper-connected society, or information society, brings new challenges and opportunities related to the use of massive data (Big Data) that forces us to rethink our relationship with reality and the traditional ways of managing health information. PMID:26338398

  5. Improve Synergy Between Health Information Exchange and Electronic Health Records to Increase Rates of Continuously Insured Patients

    PubMed Central

    Gold, Rachel; Burdick, Tim; Angier, Heather; Wallace, Lorraine; Nelson, Christine; Likumahuwa-Ackman, Sonja; Sumic, Aleksandra; DeVoe, Jennifer E.

    2015-01-01

    Introduction: The Affordable Care Act increases health insurance options, yet many Americans may struggle to consistently maintain coverage. While health care providers have traditionally not been involved in providing insurance enrollment support to their patients, the ability for them to do so now exists. We propose that providers could capitalize on the expansion of electronic health records (EHRs) and the advances in health information exchanges (HIEs) to improve their patients’ insurance coverage rates and continuity. Evidence for Argument: We describe a project in which we are building strategies for linking, and thus improving synergy between, payer and EHR data. Through this effort, care teams will have access to new automated tools and increased EHR functionality designed to help them assist their patients in obtaining and maintaining health insurance coverage. Suggestion for the Future: The convergence of increasing EHR adoption, improving HIE functionality, and expanding insurance coverage options, creates new opportunities for clinics to help their patients obtain public health insurance. Harnessing this nascent ability to exchange information between payers and providers may improve synergies between HIE and EHRs, and thus support clinic-based efforts to keep patients continuously insured. PMID:26355818

  6. Organizational complements to electronic health records in ambulatory physician performance: the role of support staff

    PubMed Central

    Jha, Ashish K

    2012-01-01

    In industries outside healthcare, highly skilled employees enable substantial gains in productivity after adoption of information technologies. The authors explore whether the presence of highly skilled, autonomous clinical support staff is associated with higher performance among physicians with electronic health records (EHRs). Using data from a survey of general internists, the authors assessed whether physicians with EHRs were more likely to be top performers on cost and quality if they worked with nurse practitioners or physician assistants. It was found that, among physicians with EHRs, those with highly skilled, autonomous staff were far more likely to be top performing than those without such staff (OR 7.0, 95% CI 1.7 to 34.8, p=0.02). This relationship did not hold among physicians without EHRs (OR 1.0). As we begin a national push towards greater EHR adoption, it is critical to understand why some physicians gain from EHR use and others do not. PMID:22517802

  7. MDPHnet: secure, distributed sharing of electronic health record data for public health surveillance, evaluation, and planning.

    PubMed

    Vogel, Joshua; Brown, Jeffrey S; Land, Thomas; Platt, Richard; Klompas, Michael

    2014-12-01

    Electronic health record systems contain clinically detailed data from large populations of patients that could significantly enrich public health surveillance. Clinical practices' security, privacy, and proprietary concerns, however, have limited their willingness to share these data with public health agencies. We describe a novel distributed network for public health surveillance called MDPHnet. The system allows the Massachusetts Department of Public Health (MDPH) to initiate custom queries against participating practices' electronic health records while the data remain behind each practice's firewall. Practices can review proposed queries before execution and approve query results before releasing them to the health department. MDPH is using the system for routine surveillance for priority conditions and to evaluate the impact of public health interventions. PMID:25322301

  8. Factors Affecting the Adoption of Electronic Books by Undergraduate Students in a Small, Midwestern, Liberal Arts University

    ERIC Educational Resources Information Center

    Walton, Edward W.

    2012-01-01

    Many academic libraries were early adopters of e-books and continue to acquire e-books to support student learning. The e-book is an innovation that purports to replace the printed book; however, students continue to prefer to use the printed book. While students prefer the printed book, academic libraries that provide access to e-books report…

  9. Future of electronic health records: implications for decision support.

    PubMed

    Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

    2012-01-01

    The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data

  10. CDC and ATSDR electronic information resources for health officers.

    PubMed

    Friede, A; O'Carroll, P W

    1996-12-01

    This article catalogs some of the Centers for Disease Control and Prevention's (CDC) more important information resource offerings, which make public health information accessible via computer and automated telephone systems and on electronic media (diskette and CD-ROM). We review mechanisms for (1) finding and retrieving CDC reports, (2) querying CDC's numeric data files, (3) transmitting surveillance and other data files to CDC, (4) exchanging electronic mail with CDC staff, and (5) disseminating state and local public health information and data by using CDC tools. Each resource is followed with a section on how to obtain access to these resources.

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

    PubMed

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

    2012-01-01

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

  12. Template and Model Driven Development of Standardized Electronic Health Records.

    PubMed

    Kropf, Stefan; Chalopin, Claire; Denecke, Kerstin

    2015-01-01

    Digital patient modeling targets the integration of distributed patient data into one overarching model. For this integration process, both a theoretical standard-based model and information structures combined with concrete instructions in form of a lightweight development process of single standardized Electronic Health Records (EHRs) are needed. In this paper, we introduce such a process along side a standard-based architecture. It allows the modeling and implementation of EHRs in a lightweight Electronic Health Record System (EHRS) core. The approach is demonstrated and tested by a prototype implementation. The results show that the suggested approach is useful and facilitates the development of standardized EHRSs. PMID:26262004

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

    PubMed Central

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

    2011-01-01

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

  14. Efficient medical information retrieval in encrypted Electronic Health Records.

    PubMed

    Pruski, Cédric; Wisniewski, François

    2012-01-01

    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.

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

    NASA Astrophysics Data System (ADS)

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

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

  16. Impacts on rural livelihoods in Cambodia following adoption of best practice health and husbandry interventions by smallholder cattle farmers.

    PubMed

    Young, J R; O'Reilly, R A; Ashley, K; Suon, S; Leoung, I V; Windsor, P A; Bush, R D

    2014-08-01

    To better understand how smallholder farmers whom own the majority of Cambodian cattle can contribute to efforts to address food security needs in the Mekong region, a five-year research project investigating methods to improve cattle health and husbandry practices was conducted. Cattle production in Cambodia is constrained by transboundary animal diseases (TADs) including foot-and-mouth disease (FMD) and haemorrhagic septicaemia (HS) plus poor nutrition, reproduction and marketing knowledge. The project worked in six villages in Kandal, Takeo and Kampong Cham province during 2007-12. Farmers from three 'high intervention' (HI) villages incrementally received a participatory extension programme that included FMD and HS vaccination, forage development and husbandry training. Evaluation of project impacts on livelihoods was facilitated by comparison with three 'low intervention' (LI) villages where farmers received vaccinations only. Results of knowledge, attitude and practice (KAP) and socio-economic surveys conducted in 2012 of 120 participating farmers identified that farmer knowledge in the HI project sites exceeded LI sites on the topics of biosecurity, internal parasites, nutrition and reproduction. HI farmers adopted biosecurity practices including a willingness to vaccinate for FMD and HS at their own cost, separate sick from healthy cattle, grow and feed forages and displayed awareness of the benefits of building fattening pens. HI farmers that grew forages observed time savings exceeding two hours per day each for men, women and children, enabling expansion of farm enterprises, secondary employment and children's schooling. Logistic regression analysis revealed that farmers in the HI group significantly increased annual household income (P < 0.001), with 53% reporting an increase of 100% or more. We conclude that improving smallholder KAP of cattle health and production can lead to improved livelihoods. This strategy should be of interest to policymakers

  17. Electronic health records: what does your signature signify?

    PubMed

    Victoroff Md, Michael S

    2012-01-01

    Electronic health records serve multiple purposes, including clinical communication, legal documentation, financial transaction capture, research and analytics. Electronic signatures attached to entries in EHRs have different logical and legal meanings for different users. Some of these are vestiges from historic paper formats that require reconsideration. Traditionally accepted functions of signatures, such as identity verification, attestation, consent, authorization and non-repudiation can become ambiguous in the context of computer-assisted workflow processes that incorporate functions like logins, auto-fill and audit trails. This article exposes the incompatibility of expectations among typical users of electronically signed information. PMID:22888846

  18. Can big data transform electronic health records into learning health systems?

    PubMed

    Harper, Ellen

    2014-01-01

    In the United States and globally, healthcare delivery is in the midst of an acute transformation with the adoption and use of health information technology (health IT) thus generating increasing amounts of patient care data available in computable form. Secure and trusted use of these data, beyond their original purpose can change the way we think about business, health, education, and innovation in the years to come. "Big Data" is data whose scale, diversity, and complexity require new architecture, techniques, algorithms, and analytics to manage it and extract value and hidden knowledge from it.

  19. Developing Electronic Cooperation Tools: A Case From Norwegian Health Care

    PubMed Central

    Mydske, Per Kristen

    2013-01-01

    Background Many countries aim to create electronic cooperational tools in health care, but the progress is rather slow. Objective The study aimed to uncover how the authoritys’ financing policies influence the development of electronic cooperational tools within public health care. Methods An interpretative approach was used in this study. We performed 30 semistructured interviews with vendors, policy makers, and public authorities. Additionally, we conducted an extensive documentation study and participated in 18 workshops concerning information and communication technology (ICT) in Norwegian health care. Results We found that the interorganizational communication in sectors like health care, that have undergone an independent development of their internal information infrastructure would find it difficult to create electronic services that interconnect the organizations because such connections would affect all interconnected organizations within the heterogenic structure. The organizations would, to a large extent, depend on new functionality in existing information systems. Electronic patient records play a central role in all parts of the health care sector and therefore dependence is established to the information systems and theirs vendors. The Norwegian government authorities, which run more than 80% of the Norwegian health care, have not taken extraordinary steps to compensate for this dependency–the government's political philosophy is that each health care institution should pay for further electronic patient record development. However, cooperational tools are complex due to the number of players involved and the way they are intertwined with the overall workflow. The customers are not able to buy new functionalities on the drawing table, while the electronic patient record vendors are not willing to take the economic risk in developing cooperational tools. Thus, the market mechanisms in the domain are challenged. We also found that public projects

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

    PubMed Central

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

    2014-01-01

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

  1. Electronic Health Record in Italy and Personal Data Protection.

    PubMed

    Bologna, Silvio; Bellavista, Alessandro; Corso, Pietro Paolo; Zangara, Gianluca

    2016-06-01

    The present article deals with the Italian Electronic Health Record (hereinafter EHR), recently introduced by Act 221/2012, with a specific focus on personal data protection. Privacy issues--e.g., informed consent, data processing, patients' rights and minors' will--are discussed within the framework of recent e-Health legislation, national Data Protection Code, the related Data Protection Authority pronouncements and EU law. The paper is aimed at discussing the problems arising from a complex, fragmentary and sometimes uncertain legal framework on e-Health.

  2. Electronic Health Record in Italy and Personal Data Protection.

    PubMed

    Bologna, Silvio; Bellavista, Alessandro; Corso, Pietro Paolo; Zangara, Gianluca

    2016-06-01

    The present article deals with the Italian Electronic Health Record (hereinafter EHR), recently introduced by Act 221/2012, with a specific focus on personal data protection. Privacy issues--e.g., informed consent, data processing, patients' rights and minors' will--are discussed within the framework of recent e-Health legislation, national Data Protection Code, the related Data Protection Authority pronouncements and EU law. The paper is aimed at discussing the problems arising from a complex, fragmentary and sometimes uncertain legal framework on e-Health. PMID:27491249

  3. The electronic cigarette: potential health benefit or mere business?

    PubMed

    De Marco, Cinzia; Invernizzi, Giovanni; Bosi, Sandra; Pozzi, Paolo; Di Paco, Adriano; Mazza, Roberto; Ruprecht, Ario Alberto; Munarini, Elena; Boffi, Roberto

    2013-01-01

    Electronic cigarettes (e-cigarettes) have attracted considerable attention as a possible alternative to tobacco cigarettes, but uncertainties about their impact on health and indoor air quality as well as their commercial success without a clear regulatory framework are arousing concern. We have therefore tried to summarize the health-related implications of the use of e-cigarettes in order to help physicians and health professionals provide accurate information on this device. Given the lack of unequivocal scientific data on their toxicity and safety, we conclude that at the moment there is no reason to approve e-cigarettes as a safe alternative to tobacco smoke.

  4. Electronic Health Object: Transforming Health Care Systems From Static to Interactive and Extensible.

    PubMed

    Almunawar, Mohammad Nabil; Anshari, Muhammad; Younis, Mustafa Z; Kisa, Adnan

    2015-01-01

    Electronic health records (EHRs) store health-related patient information in an electronic format, improving the quality of health care management and increasing efficiency of health care processes. However, in existing information systems, health-related records are generated, managed, and controlled by health care organizations. Patients are perceived as recipients of care and normally cannot directly interact with the system that stores their health-related records; their participation in enriching this information is not possible. Many businesses now allow customers to participate in generating information for their systems, strengthening customer relationships. This trend is supported by Web 2.0, which enables interactivity through various means, including social networks. Health care systems should be able to take advantage of this development. This article proposes a novel framework in addressing the emerging need for interactivity while preserving and extending existing electronic medical data. The framework has 3 dimensions of patient health record: personal, social, and medical dimensions. The framework is designed to empower patients, changing their roles from static recipient of health care services to dynamic and active partners in health care processes.

  5. Electronic Health Object: Transforming Health Care Systems From Static to Interactive and Extensible.

    PubMed

    Almunawar, Mohammad Nabil; Anshari, Muhammad; Younis, Mustafa Z; Kisa, Adnan

    2015-01-01

    Electronic health records (EHRs) store health-related patient information in an electronic format, improving the quality of health care management and increasing efficiency of health care processes. However, in existing information systems, health-related records are generated, managed, and controlled by health care organizations. Patients are perceived as recipients of care and normally cannot directly interact with the system that stores their health-related records; their participation in enriching this information is not possible. Many businesses now allow customers to participate in generating information for their systems, strengthening customer relationships. This trend is supported by Web 2.0, which enables interactivity through various means, including social networks. Health care systems should be able to take advantage of this development. This article proposes a novel framework in addressing the emerging need for interactivity while preserving and extending existing electronic medical data. The framework has 3 dimensions of patient health record: personal, social, and medical dimensions. The framework is designed to empower patients, changing their roles from static recipient of health care services to dynamic and active partners in health care processes. PMID:26660486

  6. Use of Electronic Health-Related Datasets in Nursing and Health-Related Research.

    PubMed

    Al-Rawajfah, Omar M; Aloush, Sami; Hewitt, Jeanne Beauchamp

    2015-07-01

    Datasets of gigabyte size are common in medical sciences. There is increasing consensus that significant untapped knowledge lies hidden in these large datasets. This review article aims to discuss Electronic Health-Related Datasets (EHRDs) in terms of types, features, advantages, limitations, and possible use in nursing and health-related research. Major scientific databases, MEDLINE, ScienceDirect, and Scopus, were searched for studies or review articles regarding using EHRDs in research. A total number of 442 articles were located. After application of study inclusion criteria, 113 articles were included in the final review. EHRDs were categorized into Electronic Administrative Health-Related Datasets and Electronic Clinical Health-Related Datasets. Subcategories of each major category were identified. EHRDs are invaluable assets for nursing the health-related research. Advanced research skills such as using analytical softwares, advanced statistical procedures, dealing with missing data and missing variables will maximize the efficient utilization of EHRDs in research.

  7. Electronic health records in an occupational health setting-Part II. Global deployment.

    PubMed

    Bey, Jean M; de Magalhães, Josiane S; Bojórquez, Lorena; Lin, Karen

    2013-03-01

    Electronic medical record systems are being used by more multi-national corporations. This article describes one corporation's considerations and process in successfully deploying a global electronic medical record system to international facilities in Brazil, Mexico, Singapore, and Taiwan. This article summarizes feedback from the experiences of occupational health nurse superusers in these countries. PMID:23452128

  8. Electronic health records in an occupational health setting-Part II. Global deployment.

    PubMed

    Bey, Jean M; de Magalhães, Josiane S; Bojórquez, Lorena; Lin, Karen

    2013-03-01

    Electronic medical record systems are being used by more multi-national corporations. This article describes one corporation's considerations and process in successfully deploying a global electronic medical record system to international facilities in Brazil, Mexico, Singapore, and Taiwan. This article summarizes feedback from the experiences of occupational health nurse superusers in these countries.

  9. Extending Adoption of Innovation Theory with Consumer Influence the Case of Personal Health Records (PHRs) and Patient Portals

    ERIC Educational Resources Information Center

    Baird, Aaron

    2012-01-01

    A long tradition of adoption of innovations research in the information systems context suggests that innovative information systems are typically adopted by the largest companies, with the most slack resources and the most management support within competitive markets. Additionally, five behavioral characteristics (relative advantage,…

  10. Adoption and Usage of mHealth Technology on Quality and Experience of Care Provided by Frontline Workers: Observations From Rural India

    PubMed Central

    Chaturvedi, Sharad; Chaudhuri, Indrajit; Krishnan, Ram; Lesh, Neal

    2015-01-01

    Background mHealth apps are deployed with the aim of improving access, quality, and experience of health care. It is possible that any mHealth intervention can yield differential impacts for different types of users. Mediating and determining factors, including personal and socioeconomic factors, affect technology adoption, the way health workers leverage and use the technology, and subsequently the quality and experience of care they provide. Objective To develop a framework to assess whether mHealth platforms affect the quality and experience of care provided by frontline workers, and whether these effects on quality and experience are different depending on the level of technology adoption and individual characteristics of the health worker. Literacy, education, age, and previous mobile experience are identified as individual factors that affect technology adoption and use, as well as factors that affect the quality and experience of care directly and via the technology. Methods Formative research was conducted with 15 community health workers (CHWs) using CommCare, an mHealth app for maternal and newborn care, in Bihar, India. CHWs were first classified on the level of CommCare adoption using data from CommCareHQ and were then shadowed on home visits to evaluate their levels of technology proficiency, and the quality and experience of care provided. Regression techniques were employed to test the relationships. Out of all the CHWs, 2 of them refused to participate in the home visits, however, we did have information on their levels of technology adoption and background characteristics, which were included in the analysis as relevant. Results Level of technology adoption was important for both quality and experience of care. The quality score for high users of CommCare was higher by 33.4% (P=.04), on average, compared to low users of CommCare. Those who scored higher on CommCare proficiency also provided significantly higher quality and experience of care, where

  11. Some correlates of electronic health information management system success in nigerian teaching hospitals.

    PubMed

    Ojo, Adebowale I; Popoola, Sunday O

    2015-01-01

    Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS's success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals.

  12. Public trust and privacy in shared electronic health records.

    PubMed

    Rynning, Elisabeth

    2007-07-01

    The development of information and communication technology in health care, also called eHealth, is expected to improve patient safety and facilitate more efficient use of limited resources. The introduction of electronic health records (EHRs) can make possible immediate, even automatic transfer of patient data, for health care as well as other purposes, across any kind of institutional, regional or national border. Data can thus be shared and used more effectively for quality assurance, disease surveillance, public health monitoring and research. eHealth may also facilitate patient access to health information and medical treatment, and is seen as an effective tool for patient empowerment. At the same time, eHealth solutions may jeopardize both patient safety and patients' rights, unless carefully designed and used with discretion. The success of EHR systems will depend on public trust in their compatibility with fundamental rights, such as privacy and confidentiality. Shared European EHR systems require interoperability not only with regard to technological and semantic standards, but also concerning legal, social and cultural aspects. Since the area of privacy and medical confidentiality is far from harmonized across Europe, we are faced with a diversity that will make fully shared EHR systems a considerable challenge.

  13. Dissemination of an Electronic Manual to Build Capacity for Implementing Farmers' Markets with Community Health Centers.

    PubMed

    Guest, M Aaron; Freedman, Darcy; Alia, Kassandra A; Brandt, Heather M; Friedman, Daniela B

    2015-10-01

    Community-university partnerships can lend themselves to the development of tools that encourage and promote future community health development. The electronic manual, "Building Farmacies," describes an approach for developing capacity and sustaining a community health center-based farmers' market that emerged through a community-university partnership. Manual development was guided by the Knowledge to Action Framework and experiences developing a multivendor, produce-only farmers' market at a community health center in rural South Carolina. The manual was created to illustrate an innovative solution for community health development. The manual was disseminated electronically through 25 listservs and interested individuals voluntarily completed a Web-based survey to access the free manual. During the 6-month dissemination period, 271 individuals downloaded the manual. Findings highlighted the value of translating community-based participatory research into user-friendly manuals to guide future intervention development and dissemination approaches, and demonstrate the need to include capacity building opportunities to support translation and adoption of interventions.

  14. Dissemination of an Electronic Manual to Build Capacity for Implementing Farmers’ Markets with Community Health Centers

    PubMed Central

    Guest, M. Aaron; Freedman, Darcy; Alia, Kassandra A.; Brandt, Heather M.; Friedman, Daniela B.

    2015-01-01

    Community-university partnerships can lend themselves to the development of tools that encourage and promote future community health development. The electronic manual, “Building Farmacies,” describes an approach for developing capacity and sustaining a community health center-based farmers’ market that emerged through a community-university partnership. Manual development was guided by the Knowledge to Action Framework and experiences developing a multi-vendor, produce-only farmers’ market at a community health center in rural South Carolina. The manual was created to illustrate an innovative solution for community health development. The manual was disseminated electronically through 25 listservs and interested individuals voluntarily completed a web-based survey to access the free manual. During the six-month dissemination period, 271 individuals downloaded the manual. Findings highlighted the value of translating community-based participatory research into user-friendly manuals to guide future intervention development and dissemination approaches, and demonstrate the need to include capacity building opportunities to support translation and adoption of interventions. PMID:26296392

  15. Dissemination of an Electronic Manual to Build Capacity for Implementing Farmers' Markets with Community Health Centers.

    PubMed

    Guest, M Aaron; Freedman, Darcy; Alia, Kassandra A; Brandt, Heather M; Friedman, Daniela B

    2015-10-01

    Community-university partnerships can lend themselves to the development of tools that encourage and promote future community health development. The electronic manual, "Building Farmacies," describes an approach for developing capacity and sustaining a community health center-based farmers' market that emerged through a community-university partnership. Manual development was guided by the Knowledge to Action Framework and experiences developing a multivendor, produce-only farmers' market at a community health center in rural South Carolina. The manual was created to illustrate an innovative solution for community health development. The manual was disseminated electronically through 25 listservs and interested individuals voluntarily completed a Web-based survey to access the free manual. During the 6-month dissemination period, 271 individuals downloaded the manual. Findings highlighted the value of translating community-based participatory research into user-friendly manuals to guide future intervention development and dissemination approaches, and demonstrate the need to include capacity building opportunities to support translation and adoption of interventions. PMID:26296392

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

    PubMed Central

    Platt, Jodyn; Kardia, Sharon

    2015-01-01

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

  17. Ethical questions must be considered for electronic health records.

    PubMed

    Spriggs, Merle; Arnold, Michael V; Pearce, Christopher M; Fry, Craig

    2012-09-01

    National electronic health record initiatives are in progress in many countries around the world but the debate about the ethical issues and how they are to be addressed remains overshadowed by other issues. The discourse to which all others are answerable is a technical discourse, even where matters of privacy and consent are concerned. Yet a focus on technical issues and a failure to think about ethics are cited as factors in the failure of the UK health record system. In this paper, while the prime concern is the Australian Personally Controlled Electronic Health Record (PCEHR), the discussion is relevant to and informed by the international context. The authors draw attention to ethical and conceptual issues that have implications for the success or failure of electronic health records systems. Important ethical issues to consider as Australia moves towards a PCEHR system include: issues of equity that arise in the context of personal control, who benefits and who should pay, what are the legitimate uses of PCEHRs, and how we should implement privacy. The authors identify specific questions that need addressing.

  18. Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach

    PubMed Central

    Khan, Anum Irfan; Kuluski, Kerry; McKillop, Ian; Sharpe, Sarah; Bierman, Arlene S; Lyons, Renee F; Cott, Cheryl

    2016-01-01

    Background Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD. Objective This paper describes the design and development approach, specifically the process of incorporating qualitative research methods into user-centered design approaches to create the ePRO tool. Key lessons learned are offered as a guide for other eHealth and mHealth research and technology developers working with complex patient populations and their primary health care providers. Methods Guided by user-centered design principles, interpretive descriptive qualitative research methods were adopted to capture user experiences through interviews and working groups. Consistent with interpretive descriptive methods, an iterative analysis technique was used to generate findings, which were then organized in relation to the tool design and function to help systematically inform modifications to the tool. User feedback captured and analyzed through this method was used to challenge the design and inform the iterative development of the tool. Results Interviews with primary health care providers (n=7) and content experts (n=6), and four focus groups with patients and carers (n=14) along with a PICK analysis—Possible, Implementable, (to be) Challenged, (to be) Killed—guided development of the first prototype. The initial prototype was presented in three design working groups with patients/carers (n=5), providers (n=6), and experts (n=5). Working group findings were

  19. Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities

    PubMed Central

    Slight, Sarah Patricia; Berner, Eta S; Galanter, William; Huff, Stanley; Lambert, Bruce L; Lannon, Carole; Lehmann, Christoph U; McCourt, Brian J; McNamara, Michael; Menachemi, Nir; Payne, Thomas H; Spooner, S Andrew; Schiff, Gordon D; Wang, Tracy Y; Akincigil, Ayse; Crystal, Stephen; Fortmann, Stephen P; Vandermeer, Meredith L

    2015-01-01

    Background With the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for “meaningful use” (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems. Objective The Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy. Methods We gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group. Results Stakeholders’ knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs. Conclusions Although MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-06-01

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

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

    PubMed

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

    2013-06-01

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

  3. Training providers: beyond the basics of electronic health records

    PubMed Central

    2013-01-01

    Background Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities. Methods Based on feedback from providers and requests for technical support, we developed two classes designed to improve providers’ effectiveness with the electronic health record. Training took place at Kaiser Permanente, Mid-Atlantic States. The classes focused on managing patient-level information using problem lists and medication lists, as well as efficient documentation and chart review. Both classes used the blended learning method, integrating concrete scenarios, hands-on exercises and take-home materials to reinforce class concepts. To evaluate training effectiveness, we used a case–control study with a 1:4 match on pre-training performance. We measured the usage rate of two key electronic health record functions (problem list and medication list management) for six months before and after training. Change scores were compared using the Wilcoxon sign rank test. Results 36 participants and 144 non-participants were included in the training evaluation. Training participants were more likely to manage both medication lists and problem lists after training. Class material is now being incorporated into an enterprise-wide multi-modal training program available to all providers at Kaiser Permanente in the Mid-Atlantic States. Conclusions Ongoing information technology training is well-received by healthcare providers, who expressed a clear preference for additional training. Training improved use of two important electronic health record features that are included as part of the Meaningful Use criteria. PMID:24295150

  4. Implementing electronic health care predictive analytics: considerations and challenges.

    PubMed

    Amarasingham, Ruben; Patzer, Rachel E; Huesch, Marco; Nguyen, Nam Q; Xie, Bin

    2014-07-01

    The use of predictive modeling for real-time clinical decision making is increasingly recognized as a way to achieve the Triple Aim of improving outcomes, enhancing patients' experiences, and reducing health care costs. The development and validation of predictive models for clinical practice is only the initial step in the journey toward mainstream implementation of real-time point-of-care predictions. Integrating electronic health care predictive analytics (e-HPA) into the clinical work flow, testing e-HPA in a patient population, and subsequently disseminating e-HPA across US health care systems on a broad scale require thoughtful planning. Input is needed from policy makers, health care executives, researchers, and practitioners as the field evolves. This article describes some of the considerations and challenges of implementing e-HPA, including the need to ensure patients' privacy, establish a health system monitoring team to oversee implementation, incorporate predictive analytics into medical education, and make sure that electronic systems do not replace or crowd out decision making by physicians and patients.

  5. [Health consequences of smoking electronic cigarettes are poorly described].

    PubMed

    Tøttenborg, Sandra Søgaard; Holm, Astrid Ledgaard; Wibholm, Niels Christoffer; Lange, Peter

    2014-09-01

    Despite increasing popularity, health consequences of vaping (smoking electronic cigarettes, e-cigarettes) are poorly described. Few studies suggest that vaping has less deleterious effects on lung function than smoking conventional cigarettes. One large study found that e-cigarettes were as efficient as nicotine patches in smoking cessation. The long-term consequences of vaping are however unknown and while some experts are open towards e-cigarettes as a safer way of satisfying nicotine addiction, others worry that vaping in addition to presenting a health hazard may lead to an increased number of smokers of conventional cigarettes.

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

    PubMed Central

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

    2015-01-01

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

  7. Ethics and the electronic health record in dental school clinics.

    PubMed

    Cederberg, Robert A; Valenza, John A

    2012-05-01

    Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. However, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solutions for the management of ethical concerns related to EHRs in dental schools.

  8. Report Central: quality reporting tool in an electronic health record.

    PubMed

    Jung, Eunice; Li, Qi; Mangalampalli, Anil; Greim, Julie; Eskin, Michael S; Housman, Dan; Isikoff, Jeremy; Abend, Aaron H; Middleton, Blackford; Einbinder, Jonathan S

    2006-01-01

    Quality reporting tools, integrated with ambulatory electronic health records, can help clinicians and administrators understand performance, manage populations, and improve quality. Report Central is a secure web report delivery tool built on Crystal Reports XItrade mark and ASP.NET technologies. Pilot evaluation of Report Central indicates that clinicians prefer a quality reporting tool that is integrated with our home-grown EHR to support clinical workflow.

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

    NASA Astrophysics Data System (ADS)

    Slamanig, Daniel; Stingl, Christian

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

  10. Rapid progress or lengthy process? Electronic personal health records in mental health.

    PubMed

    Ennis, Liam; Rose, Diana; Callard, Felicity; Denis, Mike; Wykes, Til

    2011-01-01

    A major objective of many healthcare providers is to increase patients' participation in their own care. The introduction of electronic personal health records (ePHRs) may help to achieve this. An ePHR is an electronic database of an individual's health information, accessible to and maintained by the patient. ePHRs are very much in vogue, with an increasing number of studies reporting their potential utility as well as cost. However, the vast majority of these studies focus on general healthcare. Little attempt has been made to document the specific problems which might occur throughout the implementation of ePHRs in mental health. This review identifies such concerns through an electronic search of the literature. Several potential difficulties are highlighted and addressed, including access to information technology, identifying relevant populations and the handling of sensitive information. Special attention is paid to the concept of 'empowerment' and what this means in relation to ePHRs.

  11. A personally controlled electronic health record for Australia

    PubMed Central

    Pearce, Christopher; Bainbridge, Michael

    2014-01-01

    Objective On July 1, 2012 Australia launched a personally controlled electronic health record (PCEHR) designed around the needs of consumers. Using a distributed model and leveraging key component national eHealth infrastructure, the PCEHR is designed to enable sharing of any health information about a patient with them and any other health practitioner involved in their care to whom the patient allows access. This paper discusses the consumer-facing part of the program. Method Design of the system was through stakeholder consultation and the development of detailed requirements, followed by clinical design assurance. Results Patients are able to access any posted information through a web-accessible ‘consumer portal.’ Within the portal they are able to assert access controls on all or part of their record. The portal includes areas for consumers to record their own personal information. Discussion The PCEHR has the potential to transform the ability of patients to actively engage in their own healthcare, and to enable the emerging partnership model of health and healthcare in medicine. The ability to access health information traditionally kept within the closed walls of institutions also raises challenges for the profession, both in the language clinicians choose and the ethical issues raised by the changed roles and responsibilities. Conclusions The PCEHR is aimed at connecting all participants and their interventions, and is intended to become a system-wide activity. PMID:24650635

  12. Open source cardiology electronic health record development for DIGICARDIAC implementation

    NASA Astrophysics Data System (ADS)

    Dugarte, Nelson; Medina, Rubén.; Huiracocha, Lourdes; Rojas, Rubén.

    2015-12-01

    This article presents the development of a Cardiology Electronic Health Record (CEHR) system. Software consists of a structured algorithm designed under Health Level-7 (HL7) international standards. Novelty of the system is the integration of high resolution ECG (HRECG) signal acquisition and processing tools, patient information management tools and telecardiology tools. Acquisition tools are for management and control of the DIGICARDIAC electrocardiograph functions. Processing tools allow management of HRECG signal analysis searching for indicative patterns of cardiovascular pathologies. Telecardiology tools incorporation allows system communication with other health care centers decreasing access time to the patient information. CEHR system was completely developed using open source software. Preliminary results of process validation showed the system efficiency.

  13. Archetype Development Process of Electronic Health Record of Minas Gerais.

    PubMed

    Abreu Maia, Thais; Fernandes De Muylder, Cristiana; Mendonça Queiroga, Rodrigo

    2015-01-01

    The Electronic Health Record (EHR) supports health systems and aims to reduce fragmentation, which will enable continuity of patient care. The paper's main objective is to define the steps, roles and artifacts for an archetype development process (ADP) for the EHR at the Brazilian National Health System (SUS) in the State of Minas Gerais (MG). This study was conducted using qualitative analysis based upon an applied case. It had an exploratory purpose metodologically defined in four stages: literature review; descriptive comparison; proposition of an archetype development process and proof of concept. The proof of concept showed that the proposed ADP ensures the archetype quality and supports the semantic interoperability in SUS to improve clinical safety and the continuity of patient care.

  14. Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence

    PubMed Central

    Granger, Christopher

    2016-01-01

    Background The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. Objective The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT. Methods We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence. Results The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed. Conclusion To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues. PMID:26980270

  15. A thematic review and a policy-analysis agenda of Electronic Health Records in the Greek National Health System.

    PubMed

    Emmanouilidou, Maria; Burke, Maria

    2013-01-01

    The increasing pressure to improve healthcare outcomes and reduce costs is driving the current agenda of governments at worldwide level and calls for a fundamental reform of the status quo of health systems. This is especially the case with the Greek NHS (National Health System), a system in continuous crisis, and with the recent ongoing financial turbulence under intensive scrutiny. Technological innovations and Electronic Health Records (EHR) in particular, are recognised as key enablers in mitigating the existing burdens of healthcare. As a result, EHR is considered a core component in technology-driven reform processes. Nonetheless, the successful implementation and adoption of EHR proves to be a challenging task due to a mixture of technological, organisational and political issues. Drawing upon experiences within the European Union (EU) healthcare setting and the Greek NHS the paper proposes a conceptual framework as a policy-analysis agenda for EHR interventions in Greece. While the context of discussion is Greece, the paper aims to also derive useful insights to healthcare policy-makers around the globe.

  16. The Geisinger MyCode Community Health Initiative: an electronic health record-linked biobank for Precision Medicine research

    PubMed Central

    Carey, David J.; Fetterolf, Samantha N.; Davis, F. Daniel; Faucett, William A.; Kirchner, H. Lester; Mirshahi, Uyenlinh; Murray, Michael F.; Smelser, Diane T.; Gerhard, Glenn S.; Ledbetter, David H.

    2015-01-01

    Purpose Geisinger Health System (GHS) provides an ideal platform for Precision Medicine. Key elements are the integrated health system, stable patient population, and electronic health record (EHR) infrastructure. In 2007 Geisinger launched MyCode®, a system-wide biobanking program to link samples and EHR data for broad research use. Methods Patient-centered input into MyCode® was obtained using participant focus groups. Participation in MyCode® is based on opt-in informed consent and allows recontact, which facilitates collection of data not in the EHR, and, since 2013, the return of clinically actionable results to participants. MyCode® leverages Geisinger’s technology and clinical infrastructure for participant tracking and sample collection. Results MyCode® has a consent rate of >85% with more than 90,000 participants currently, with ongoing enrollment of ~4,000 per month. MyCode® samples have been used to generate molecular data, including high-density genotype and exome sequence data. Genotype and EHR-derived phenotype data replicate previously reported genetic associations. Conclusion The MyCode® project has created resources that enable a new model for translational research that is faster, more flexible, and more cost effective than traditional clinical research approaches. The new model is scalable, and will increase in value as these resources grow and are adopted across multiple research platforms. PMID:26866580

  17. Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation

    PubMed Central

    Cocosila, Mihail; Archer, Norm

    2014-01-01

    Objective To develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those who report being well. Materials and methods A model of PHR use motivators and barriers was built and tested through a national survey across Canada. Data were collected from 800 individuals, 18 years or older. Half reported having a chronic illness or disability and half reported being well. Analyses were performed with structural equation modelling techniques. Results A total of 389 answers from chronically ill and 383 from well participants were collected. Perceived usefulness was the key explanation of the intention to use PHRs for both ill and well people (total effect of 0.601 and 0.565, respectively) followed by security, privacy and trust in PHRs (total effect of 0.377 and 0.479, respectively). Conversely, computer anxiety was perceived as a significant barrier (total effect of −0.327 for ill individuals and −0.212 for well individuals). Discussion The model proposed was appropriate in explaining key consumer positive and negative perceptions on electronic PHR use. We found little difference in perceptions of electronic PHRs between chronically ill and well individuals, although self-reporting their health status might have influenced the results. Conclusions To increase the adoption rate of electronic PHRs among both chronically ill and well consumers it is necessary to reinforce consumer perceptions of the usefulness of and trust in these eHealth technologies while mitigating their anxieties about computer use in general. PMID:25056975

  18. Using a Patient Portal to Transmit Patient Reported Health Information into the Electronic Record: Workflow Implications and User Experience

    PubMed Central

    Sorondo, Barbara; Allen, Amy; Bayleran, Janet; Doore, Stacy; Fathima, Samreen; Sabbagh, Iyad; Newcomb, Lori

    2016-01-01

    Introduction: This project implemented an integrated patient self-reported screening tool in a patient portal and assessed clinical workflow and user experience in primary care practices. Methods: An electronic health risk assessment based on the CMS Annual Wellness Visit (AWV) was developed to integrate self-reported health information into the patient’s electronic health record (EHR). Patients enrolled in care coordination tested the implementation. The evaluation plan included quantitative and qualitative measures of patient adoption, provider adoption, workflow impact, financial impact, and technology impact. Findings: Seventy-two patients completed the sample AWV, and 80% of the questionnaires had clinical findings that required provider follow-up. Patients expressed satisfaction with the portal, as it enabled them to view their health record and enter information. Implementation did not reduce office staff time. Providers and office staff agreed that an electronic system for adding information to their record would increase patient satisfaction, but they expressed concern with the need to promptly review the information and the time involved to accomplish this prior to an office visit. Discussion: Despite satisfaction among patients, portal adoption is still low, due to technological limitations and to the lack of adaptability to primary care practice workflow. Notwithstanding those barriers, the use of the portal for completion of repetitive tasks, such as screening tools, should be encouraged. Conclusions: Patients can effectively use portals to complete the patient reported section of the CMS AWV. However, if the information is not completed during the same day of the office visit, the time required to address health findings outside of a regular office visit is uncompensated, and diminished the enthusiasm for this process among primary care practice staff.

  19. Using a Patient Portal to Transmit Patient Reported Health Information into the Electronic Record: Workflow Implications and User Experience

    PubMed Central

    Sorondo, Barbara; Allen, Amy; Bayleran, Janet; Doore, Stacy; Fathima, Samreen; Sabbagh, Iyad; Newcomb, Lori

    2016-01-01

    Introduction: This project implemented an integrated patient self-reported screening tool in a patient portal and assessed clinical workflow and user experience in primary care practices. Methods: An electronic health risk assessment based on the CMS Annual Wellness Visit (AWV) was developed to integrate self-reported health information into the patient’s electronic health record (EHR). Patients enrolled in care coordination tested the implementation. The evaluation plan included quantitative and qualitative measures of patient adoption, provider adoption, workflow impact, financial impact, and technology impact. Findings: Seventy-two patients completed the sample AWV, and 80% of the questionnaires had clinical findings that required provider follow-up. Patients expressed satisfaction with the portal, as it enabled them to view their health record and enter information. Implementation did not reduce office staff time. Providers and office staff agreed that an electronic system for adding information to their record would increase patient satisfaction, but they expressed concern with the need to promptly review the information and the time involved to accomplish this prior to an office visit. Discussion: Despite satisfaction among patients, portal adoption is still low, due to technological limitations and to the lack of adaptability to primary care practice workflow. Notwithstanding those barriers, the use of the portal for completion of repetitive tasks, such as screening tools, should be encouraged. Conclusions: Patients can effectively use portals to complete the patient reported section of the CMS AWV. However, if the information is not completed during the same day of the office visit, the time required to address health findings outside of a regular office visit is uncompensated, and diminished the enthusiasm for this process among primary care practice staff. PMID:27683669

  20. Who Is Adopted? Measuring Adoption Status Using National Survey Data.

    ERIC Educational Resources Information Center

    Miller, Brent C.; Bayley, Bruce K.; Christensen, Mathew; Fan, Xitao; Coyl, Diana; Grotevant, Harold D.; van Dulmen, Manfred; Dunbar, Nora

    2001-01-01

    Draws on data from the National Longitudinal Survey of Adolescent Health to illustrate the complexities of using large-scale surveys to measure adoption status. Discusses conceptual and methodological issues in measuring adoption status. Presents decision rules for determining adoption status across three sources of data: school self-administered…

  1. Electronic Health Record-Driven Workflow for Diagnostic Radiologists.

    PubMed

    Geeslin, Matthew G; Gaskin, Cree M

    2016-01-01

    In most settings, radiologists maintain a high-throughput practice in which efficiency is crucial. The conversion from film-based to digital study interpretation and data storage launched the era of PACS-driven workflow, leading to significant gains in speed. The advent of electronic health records improved radiologists' access to patient data; however, many still find this aspect of workflow to be relatively cumbersome. Nevertheless, the ability to guide a diagnostic interpretation with clinical information, beyond that provided in the examination indication, can add significantly to the specificity of a radiologist's interpretation. Responsibilities of the radiologist include, but are not limited to, protocoling examinations, interpreting studies, chart review, peer review, writing notes, placing orders, and communicating with referring providers. Most of the aforementioned activities are not PACS-centric and require a login to one or more additional applications. Consolidation of these tasks for completion through a single interface can simplify workflow, save time, and potentially reduce the incidence of errors. Here, the authors describe diagnostic radiology workflow that leverages the electronic health record to significantly add to a radiologist's ability to be part of the health care team, provide relevant interpretations, and improve efficiency and quality. PMID:26603098

  2. Attitude Towards Health Information Privacy and Electronic Health Records Among Urban Sri Lankan Adults.

    PubMed

    Tissera, Shaluni R; Silva, S N

    2016-01-01

    Sri Lanka is planning to move towards an Electronic Health Record (EHR) system. This research argues that the public preparedness should be considered in order to implement a functioning and an effective EHR system in a country. When asked about how concerned the participants were about the security of their health records, 40.5% stated they were concerned and 38.8% were very concerned. They were asked to rate the 'level of trust' they have on health institutes in Sri Lanka on a scale from 1 to 10 (1 lowest level of trust and 10 highest), 66.1% rated at level 5 or less. PMID:27332453

  3. Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

    ERIC Educational Resources Information Center

    Daniels, Cheryl Andrea

    2013-01-01

    With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

  4. Technical Limitations of Electronic Health Records in Community Health Centers: Implications on Ambulatory Care Quality

    ERIC Educational Resources Information Center

    West, Christopher E.

    2010-01-01

    Research objectives: This dissertation examines the state of development of each of the eight core electronic health record (EHR) functionalities as described by the IOM and describes how the current state of these functionalities limit quality improvement efforts in ambulatory care settings. There is a great deal of literature describing both the…

  5. [The electronic health record: computerised provider order entry and the electronic instruction document as new functionalities].

    PubMed

    Derikx, Joep P M; Erdkamp, Frans L G; Hoofwijk, A G M

    2013-01-01

    An electronic health record (EHR) should provide 4 key functionalities: (a) documenting patient data; (b) facilitating computerised provider order entry; (c) displaying the results of diagnostic research; and (d) providing support for healthcare providers in the clinical decision-making process.- Computerised provider order entry into the EHR enables the electronic receipt and transfer of orders to ancillary departments, which can take the place of handwritten orders.- By classifying the computer provider order entries according to disorders, digital care pathways can be created. Such care pathways could result in faster and improved diagnostics.- Communicating by means of an electronic instruction document that is linked to a computerised provider order entry facilitates the provision of healthcare in a safer, more efficient and auditable manner.- The implementation of a full-scale EHR has been delayed as a result of economic, technical and legal barriers, as well as some resistance by physicians.

  6. 45 CFR 162.1601 - Health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health care electronic funds transfers (EFT) and... SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Electronic Funds Transfers (EFT) and Remittance Advice § 162.1601 Health care electronic funds transfers...

  7. 45 CFR 162.1601 - Health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Health care electronic funds transfers (EFT) and... SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Electronic Funds Transfers (EFT) and Remittance Advice § 162.1601 Health care electronic funds transfers...

  8. 45 CFR 162.1601 - Health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health care electronic funds transfers (EFT) and... Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Electronic Funds Transfers (EFT) and Remittance Advice § 162.1601 Health care electronic funds transfers...

  9. Variability in Electronic Health Record Usage and Perceptions among Specialty vs. Primary Care Physicians.

    PubMed

    Redd, Travis K; Doberne, Julie W; Lattin, Daniel; Yackel, Thomas R; Eriksson, Carl O; Mohan, Vishnu; Gold, Jeffrey A; Ash, Joan S; Chiang, Michael F

    2015-01-01

    Despite federal incentives for adoption of electronic health records (EHRs), surveys have shown that EHR use is less common among specialty physicians than generalists. Concerns have been raised that current-generation EHR systems are inadequate to meet the unique information gathering needs of specialists. This study sought to identify whether information gathering needs and EHR usage patterns are different between specialists and generalists, and if so, to characterize their precise nature. We found that specialists and generalists have significantly different perceptions of which elements of the EHR are most important and how well these systems are suited to displaying clinical information. Resolution of these disparities could have implications for clinical productivity and efficiency, patient and physician satisfaction, and the ability of clinical practices to achieve Meaningful Use incentives.

  10. Intelligent use and clinical benefits of electronic health records in rheumatoid arthritis.

    PubMed

    Carroll, Robert J; Eyler, Anne E; Denny, Joshua C

    2015-03-01

    In the past 10 years, electronic health records (EHRs) have had growing impact in clinical care. EHRs efficiently capture and reuse clinical information, which can directly benefit patient care by guiding treatments and providing effective reminders for best practices. The increased adoption has also lead to more complex implementations, including robust, disease-specific tools, such as for rheumatoid arthritis (RA). In addition, the data collected through normal clinical care is also used in secondary research, helping to refine patient treatment for the future. Although few studies have directly demonstrated benefits for direct clinical care of RA, the opposite is true for EHR-based research - RA has been a particularly fertile ground for clinical and genomic research that have leveraged typically advanced informatics methods to accurately define RA populations. We discuss the clinical impact of EHRs in RA treatment and their impact on secondary research, and provide recommendations for improved utility in future EHR installations.

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

    PubMed Central

    Bowman, Sue

    2013-01-01

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

  12. Opportunities and challenges in leveraging electronic health record data in oncology.

    PubMed

    Berger, Marc L; Curtis, Melissa D; Smith, Gregory; Harnett, James; Abernethy, Amy P

    2016-05-01

    The widespread adoption of electronic health records (EHRs) and the growing wealth of digitized information sources about patients is ushering in an era of 'Big Data' that may revolutionize clinical research in oncology. Research will likely be more efficient and potentially more accurate than the current gold standard of manual chart review studies. However, EHRs as they exist today have significant limitations: important data elements are missing or are only captured in free text or PDF documents. Using two case studies, we illustrate the challenges of leveraging the data that are routinely collected by the healthcare system in EHRs (e.g., real-world data), specific challenges encountered in the cancer domain and opportunities that can be achieved when these are overcome.

  13. Opportunities and challenges in leveraging electronic health record data in oncology.

    PubMed

    Berger, Marc L; Curtis, Melissa D; Smith, Gregory; Harnett, James; Abernethy, Amy P

    2016-05-01

    The widespread adoption of electronic health records (EHRs) and the growing wealth of digitized information sources about patients is ushering in an era of 'Big Data' that may revolutionize clinical research in oncology. Research will likely be more efficient and potentially more accurate than the current gold standard of manual chart review studies. However, EHRs as they exist today have significant limitations: important data elements are missing or are only captured in free text or PDF documents. Using two case studies, we illustrate the challenges of leveraging the data that are routinely collected by the healthcare system in EHRs (e.g., real-world data), specific challenges encountered in the cancer domain and opportunities that can be achieved when these are overcome. PMID:27096309

  14. Specialty Task Force: A Strategic Component to Electronic Health Record (EHR) Optimization.

    PubMed

    Romero, Mary Rachel; Staub, Allison

    2016-01-01

    Post-implementation stage comes after an electronic health record (EHR) deployment. Analyst and end users deal with the reality that some of the concepts and designs initially planned and created may not be complementary to the workflow; creating anxiety, dissatisfaction, and failure with early adoption of system. Problems encountered during deployment are numerous and can vary from simple to complex. Redundant ticket submission creates backlog for Information Technology personnel resulting in delays in resolving concerns with EHR system. The process of optimization allows for evaluation of system and reassessment of users' needs. A solid and well executed optimization infrastructure can help minimize unexpected end-user disruptions and help tailor the system to meet regulatory agency goals and practice standards. A well device plan to resolve problems during post implementation is necessary for cost containment and to streamline communication efforts. Creating a specialty specific collaborative task force is efficacious and expedites resolution of users' concerns through a more structured process. PMID:27332478

  15. Application of routine electronic health record databases for pharmacogenetic research.

    PubMed

    Yasmina, A; Deneer, V H M; Maitland-van der Zee, A H; van Staa, T P; de Boer, A; Klungel, O H

    2014-06-01

    Inter-individual variability in drug responses is a common problem in pharmacotherapy. Several factors (non-genetic and genetic) influence drug responses in patients. When aiming to obtain an optimal benefit-risk ratio of medicines and with the emergence of genotyping technology, pharmacogenetic studies are important for providing recommendations on drug treatments. Advances in electronic healthcare information systems can contribute to increasing the quality and efficiency of such studies. This review describes the definition of pharmacogenetics, gene selection and study design for pharmacogenetic research. It also summarizes the potential of linking pharmacoepidemiology and pharmacogenetics (along with its strengths and limitations) and provides examples of pharmacogenetic studies utilizing electronic health record databases. PMID:24581153

  16. Health information technology: revisions to the 2014 edition electronic health record certification criteria; and Medicare and Medicaid programs; revisions to the Electronic Health Record Incentive Program. Interim final rule with comment period.

    PubMed

    2012-12-01

    The Department of Health and Human Services (HHS) is issuing this interim final rule with comment period to replace the Data Element Catalog (DEC) standard and the Quality Reporting Document Architecture (QRDA) Category III standard adopted in the final rule published on September 4, 2012 in the Federal Register with updated versions of those standards. This interim final rule with comment period also revises the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs by adding an alternative measure for the Stage 2 meaningful use (MU) objective for hospitals to provide structured electronic laboratory results to ambulatory providers, correcting the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission, and making the case number threshold exemption for clinical quality measure (CQM) reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. This rule also provides notice of CMS's intention to issue technical corrections to the electronic specifications for CQMs released on October 25, 2012. PMID:23227573

  17. Securing electronic health records with broadcast encryption schemes.

    PubMed

    Susilo, Willy; Win, Khin Than

    2006-01-01

    Information security is a concern in integrated electronic health record systems (EHRs). This paper discusses the development of a mathematical model to secure the access of EHRs. In this paper, we incorporate the notion of a broadcast encryption scheme for securing EHRs. We present a novel solution to allow a secure access to the EHRs whilst minimising the number of the encrypted ciphertexts. In a nutshell, our proposed solution enjoys shorter ciphertexts compared to having multiple ciphertexts encrypted for several different participants. Our proposed solution is applicable in practice to solve an existing open problem in the effort of securing EHRs.

  18. Electronic media, violence, and adolescents: an emerging public health problem.

    PubMed

    David-Ferdon, Corinne; Hertz, Marci Feldman

    2007-12-01

    Adolescents' access to and use of new media technology (e.g., cell phone, personal data assistant, computer for Internet access) are on the rise, and this explosion of technology brings with it potential benefits and risks. Attention is growing about the risk of adolescents to become victims of aggression perpetrated by peers with new technology. In September 2006, the Centers for Disease Control and Prevention convened a panel of experts in technology and youth aggression to examine this specific risk. This special issue of the Journal of Adolescent Health presents the data and recommendations for future directions discussed at the meeting. The articles in the Journal support the argument that electronic aggression is an emerging public health problem in need of additional prevalence and etiological research to support the development and evaluation of effective prevention programs. PMID:18047940

  19. Disrupting Electronic Health Records Systems: The Next Generation

    PubMed Central

    Marshall, Jeffrey David; Lai, Yuan

    2015-01-01

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

  20. Unemployment, measured and perceived decline of economic resources: contrasting three measures of recessionary hardships and their implications for adopting negative health behaviors.

    PubMed

    Kalousova, Lucie; Burgard, Sarah A

    2014-04-01

    Economic downturns could have long-term impacts on population health if they promote changes in health behaviors, but the evidence for whether people are more or less likely to adopt negative health behaviors in economically challenging times has been mixed. This paper argues that researchers need to draw more careful distinctions amongst different types of recessionary hardships and the mechanisms that may underlie their associations with health behaviors. We focus on unemployment experience, measured decline in economic resources, and perceived decline in economic resources, all of which are likely to occur more often during recessions, and explore whether their associations with health behaviors are consistent or different. We use population-based longitudinal data collected by the Michigan Recession and Recovery Study in the wake of the Great Recession in the United States. We evaluate whether those who had experienced each of these three hardships were more likely to adopt new negative health behaviors, specifically cigarette smoking, harmful and hazardous alcohol consumption, or marijuana consumption. We find that, net of controls and the other two recessionary hardships, unemployment experience was associated with increased hazard of starting marijuana use. Measured decline in economic resources was associated with increased hazard of cigarette smoking and lower hazard of starting marijuana use. Perceived decline in economic resources was linked to taking up harmful and hazardous drinking. Our results suggest heterogeneity in the pathways that connect hardship experiences and different health behaviors. They also indicate that relying on only one measure of hardship, as many past studies have done, could lead to an incomplete understanding of the relationship between economic distress and health behaviors.

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

    PubMed

    Blobel, Bernd

    2004-03-31

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

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

    PubMed

    Blobel, Bernd

    2004-03-31

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

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

    MedlinePlus

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

  4. 76 FR 40454 - Proposed Information Collection (VSO Access to VHA Electronic Health Records) Activity; Comment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    ... AFFAIRS Proposed Information Collection (VSO Access to VHA Electronic Health Records) Activity; Comment Request AGENCY: Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Health Administration (VHA) is announcing an opportunity for public comment on...

  5. Oral Health Promotion and Homelessness: A Theory-Based Approach to Understanding Processes of Implementation and Adoption

    ERIC Educational Resources Information Center

    Beaton, Laura; Freeman, Ruth

    2016-01-01

    Objective: To use the Theory of Diffusion of Innovations as a framework to explore the qualitative data gleaned from a process evaluation of the Smile4life intervention across Scottish National Health Service (NHS) Boards and to inform future oral health promotion and homelessness. Design: A qualitative exploration. Setting: In 2012, the…

  6. Experience, Adoption, and Technology: Exploring the Phenomenological Experiences of Faculty Involved in Online Teaching at One School of Public Health

    ERIC Educational Resources Information Center

    Kidd, Terry; Davis, Trina; Larke, Patricia

    2016-01-01

    Using the Unified Theory of Acceptance and Use of Technology (UTAUT) and Dewey's Theory of Experience, this phenomenological study explored the experiences of faculty who engaged in online teaching at one school of public health. Findings revealed that the experiences of public health faculty, who engaged in online teaching, are similar and…

  7. Adopting an ethical approach to global health training: the evolution of the Botswana - University of Pennsylvania partnership.

    PubMed

    Dacso, Matthew; Chandra, Amit; Friedman, Harvey

    2013-11-01

    Global health training opportunities for medical students and residents have proliferated in recent years. These short-term elective rotations allow trainees to learn about global health issues by participating in various aspects of education and health care in resource-limited settings. Recently published consensus-based ethical guidelines have suggested considerations for the design of international electives that address the activities of host and sending sites, visiting students and residents, and sponsors.The authors analyze the value of global health training opportunities for medical students, residents, faculty, host and sending institutions, and other stakeholders from the perspective of the Botswana-University of Pennsylvania Partnership, a program that has provided global health experiences for health care trainees for more than 10 years. Drawing from the Working Group on Ethics Guidelines for Global Health Training framework, they illustrate the ethical and logistical challenges faced by the program's organizers and the solutions that they implemented alongside their host site partners. They conclude with a summary of recommendations to guide implementation of ethically sound international health electives in resource-limited settings.

  8. Educational Mixology: A Pedagogical Approach to Promoting Adoption of Technology to Support New Learning Models in Health Science Disciplines

    ERIC Educational Resources Information Center

    McDonald, Paige L.; Lyons, Laurie B.; Straker, Howard O.; Barnett, Jacqueline S.; Schlumpf, Karen S.; Cotton, Linda; Corcoran, Mary A.

    2014-01-01

    For disciplines heavily reliant upon traditional classroom teaching, such as medicine and health sciences, incorporating new learning models may pose challenges for students and faculty. In an effort to innovate curricula, better align courses to required student learning outcomes, and address the call to redesign health professions education,…

  9. Adopting an ethical approach to global health training: the evolution of the Botswana - University of Pennsylvania partnership.

    PubMed

    Dacso, Matthew; Chandra, Amit; Friedman, Harvey

    2013-11-01

    Global health training opportunities for medical students and residents have proliferated in recent years. These short-term elective rotations allow trainees to learn about global health issues by participating in various aspects of education and health care in resource-limited settings. Recently published consensus-based ethical guidelines have suggested considerations for the design of international electives that address the activities of host and sending sites, visiting students and residents, and sponsors.The authors analyze the value of global health training opportunities for medical students, residents, faculty, host and sending institutions, and other stakeholders from the perspective of the Botswana-University of Pennsylvania Partnership, a program that has provided global health experiences for health care trainees for more than 10 years. Drawing from the Working Group on Ethics Guidelines for Global Health Training framework, they illustrate the ethical and logistical challenges faced by the program's organizers and the solutions that they implemented alongside their host site partners. They conclude with a summary of recommendations to guide implementation of ethically sound international health electives in resource-limited settings. PMID:24072119

  10. 42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD...

  11. Using ISO 25040 standard for evaluating electronic health record systems.

    PubMed

    Oliveira, Marília; Novaes, Magdala; Vasconcelos, Alexandre

    2013-01-01

    Quality of electronic health record systems (EHR-S) is one of the key points in the discussion about the safe use of this kind of system. It stimulates creation of technical standards and certifications in order to establish the minimum requirements expected for these systems. [1] In other side, EHR-S suppliers need to invest in evaluation of their products to provide systems according to these requirements. This work presents a proposal of use ISO 25040 standard, which focuses on the evaluation of software products, for define a model of evaluation of EHR-S in relation to Brazilian Certification for Electronic Health Record Systems - SBIS-CFM Certification. Proposal instantiates the process described in ISO 25040 standard using the set of requirements that is scope of the Brazilian certification. As first results, this research has produced an evaluation model and a scale for classify an EHR-S about its compliance level in relation to certification. This work in progress is part for the acquisition of the degree of master in Computer Science at the Federal University of Pernambuco.

  12. Ethical governance in biobanks linked to electronic health records.

    PubMed

    Caenazzo, L; Tozzo, P; Borovecki, A

    2015-11-01

    In the last years an alternative to traditional research projects conducted with patients has emerged: it is represented by the pairing of different type of disease biobanks specimens with Electronic Health Records (EHRs). Even if informed consent remains one of the most contested issues of biobank policy, other ethical challenges still require careful attention, given that additional issues are related to the use of EHRs. In this new way of doing research harmonization of governance is essential in practice, with the aim to make the most use of resources at our disposal, and sharing of samples and data among researchers under common policies regulating the distribution and the use. A biobank-specific Ethics Committee could be seen as a new and type of Ethics Committee, that we suggest to be applied to each biobank, with possible different functions. In particular, considering the possible use of electronic health record data linked to biological specimens in biobanking research, this specific Ethics Committee could draft best practice and ethical guidelines for the utilisation of the EHRs as a tool for genetic research, addressing concerns on accessibility, return of results and privacy and help to educate patients and healthcare providers. PMID:26592845

  13. Standards for the Content of the Electronic Health Record

    PubMed Central

    Watzlaf, Valerie J.M; Zeng, Xiaoming; Jarymowycz, Christine; Firouzan, Patti Anania

    2004-01-01

    A descriptive, cross-sectional study was performed to measure the awareness, use, and validity of the minimum content recommended in the American Society for Testing and Materials (ASTM) standards for content and structure of electronic health records. A Web-based survey was developed and used as the primary tool to collect this data. Data was collected from a random sample of healthcare facilities from across the country, vendors, and volunteers. Thirteen percent of respondents had an electronic health record (EHR) system fully in place while 10 percent did not have or did not plan to have an EHR system. The majority of respondents (62 percent) used a vendor system for EHR development. The majority of respondents were not aware or slightly aware of the ASTM E1384 standards. Respondents believed that the minimum data elements outlined in the ASTM standards should be included in all EHR systems. Data items such as educational level, patient instructions related to disposition, problem numbers, treatment plan ID, provider agency ID code, and medication date of last refill should not always be included in EHR systems. PMID:18066381

  14. Ethical governance in biobanks linked to electronic health records.

    PubMed

    Caenazzo, L; Tozzo, P; Borovecki, A

    2015-11-01

    In the last years an alternative to traditional research projects conducted with patients has emerged: it is represented by the pairing of different type of disease biobanks specimens with Electronic Health Records (EHRs). Even if informed consent remains one of the most contested issues of biobank policy, other ethical challenges still require careful attention, given that additional issues are related to the use of EHRs. In this new way of doing research harmonization of governance is essential in practice, with the aim to make the most use of resources at our disposal, and sharing of samples and data among researchers under common policies regulating the distribution and the use. A biobank-specific Ethics Committee could be seen as a new and type of Ethics Committee, that we suggest to be applied to each biobank, with possible different functions. In particular, considering the possible use of electronic health record data linked to biological specimens in biobanking research, this specific Ethics Committee could draft best practice and ethical guidelines for the utilisation of the EHRs as a tool for genetic research, addressing concerns on accessibility, return of results and privacy and help to educate patients and healthcare providers.

  15. Health Considerations in Regulation and Taxation of Electronic Cigarettes.

    PubMed

    Mainous, Arch G; Tanner, Rebecca J; Mainous, Ryan W; Talbert, Jeffery

    2015-01-01

    The use of electronic cigarettes (e-cigarettes) is experiencing unprecedented growth. This can be contrasted to the use of conventional cigarettes which showed a decrease among adults with the current smoker prevalence dropping from 20.9% in 2005 to 17.8% in 2013. There is some data that e-cigarettes are attracting both former smokers and never smokers, and in particular, young people as users. Currently most states do not tax e-cigarettes. Taxation and regulation may have a similar overall goal of decreasing smoking but regulation tends to focus reduced availability of products. In terms of tobacco control, taxation focuses on the demand side of the equation. Taxation is a distinct strategy from regulation and has been shown to decrease new adopters of conventional cigarettes. A variety of potential taxation strategies can be considered by policymakers based on different assumptions about e-cigarettes and their utility, ranging from untaxed to taxation at moderate levels compared to conventional cigarettes to taxation equal to conventional cigarettes. Until more evidence for the benefits of e-cigarettes is presented, it seems prudent to view them as a potentially harmful and addictive product that ought to be regulated and taxed in an equivalent manner to conventional cigarettes. PMID:26546657

  16. Health Considerations in Regulation and Taxation of Electronic Cigarettes.

    PubMed

    Mainous, Arch G; Tanner, Rebecca J; Mainous, Ryan W; Talbert, Jeffery

    2015-01-01

    The use of electronic cigarettes (e-cigarettes) is experiencing unprecedented growth. This can be contrasted to the use of conventional cigarettes which showed a decrease among adults with the current smoker prevalence dropping from 20.9% in 2005 to 17.8% in 2013. There is some data that e-cigarettes are attracting both former smokers and never smokers, and in particular, young people as users. Currently most states do not tax e-cigarettes. Taxation and regulation may have a similar overall goal of decreasing smoking but regulation tends to focus reduced availability of products. In terms of tobacco control, taxation focuses on the demand side of the equation. Taxation is a distinct strategy from regulation and has been shown to decrease new adopters of conventional cigarettes. A variety of potential taxation strategies can be considered by policymakers based on different assumptions about e-cigarettes and their utility, ranging from untaxed to taxation at moderate levels compared to conventional cigarettes to taxation equal to conventional cigarettes. Until more evidence for the benefits of e-cigarettes is presented, it seems prudent to view them as a potentially harmful and addictive product that ought to be regulated and taxed in an equivalent manner to conventional cigarettes.

  17. A non-repudiated and traceable authorization system based on electronic health insurance cards.

    PubMed

    Chen, Chin-Ling; Lu, Ming-Shaw; Guo, Zong-Min

    2012-08-01

    Since anamnesis management in health care is directly relative to patients' privacy protection, how to resist malicious behaviors is an important issue in information security. In recent years, the developed electronic health insurance cards (eHIC) has been widely adopted as an identification certificate, which involves lots applications and provides convenience to both the patients and relative medical workers as well. There always existed some disputes and moral standards for these medical doctors who are to be confronted with these challenges. For example: The doctor discloses patient's anamnesis without patient's consent and anamnesis by the illegal access…etc. As required in E-Health, the current systems are almost offline system, which are not suitable to support online E-anamnesis sharing access to reduce the consumption of the medical treatment and fulfill a secure audit channel. In this paper, to solve these problems, an eHIC-based online authorization system with non-repudiated and traceable properties is proposed. According to our simulation results, not only the patient's privacy could be fully protected, but also the medical revenue could be raised extensively.

  18. Navigating ethical issues with electronic health records in developmental-behavioral pediatric practice.

    PubMed

    Nielsen, Britt A; Baum, Rebecca A; Soares, Neelkamal S

    2013-01-01

    The increasing use of electronic health records (EHRs) allows for sharing of information across clinicians, quick access to laboratory results, and supports for documentation. However, this environment raises new issues of ethics and privacy, and it magnifies other issues that existed with paper records. In developmental-behavioral pediatrics (DBP) practice, which relies heavily on a team approach to blend pediatrics, mental health, and allied health, these issues are even more complicated. In this review, we highlight the ethical and privacy issues in DBP practice related to EHR use. Case examples illustrate the potential risks related to EHR access, confidentiality, and interprofessional collaboration. Suggestions to mitigate some of the ethical and privacy issues associated with EHRs at both an administrative level and a clinician level are included. With the expected increase in the adoption of EHRs by DBP clinicians in the near future, professional standards will need to be defined, and novel technological solutions may offer additional safeguards. Until then, professionals and organizations are responsible to uphold the standards of ethical practice while promoting effective information exchange to facilitate clinical care. PMID:23275058

  19. How bioethics principles can aid design of electronic health records to accommodate patient granular control.

    PubMed

    Meslin, Eric M; Schwartz, Peter H

    2015-01-01

    Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was recently adopted by a team of informaticists who are designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and nonmaleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper, we show how using ethical principles can help in the design of EHRs by first explaining how ethical principles can and should be used generally, and then by discussing how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest.

  20. Development and implementation of an electronic health record generated surgical handoff and rounding tool.

    PubMed

    Raval, Mehul V; Rust, Laura; Thakkar, Rajan K; Kurtovic, Kelli J; Nwomeh, Benedict C; Besner, Gail E; Kenney, Brian D

    2015-02-01

    Electronic health records (EHR) have been adopted across the nation at tremendous effort and expense. The purpose of this study was to assess improvements in accuracy, efficiency, and patient safety for a high-volume pediatric surgical service with adoption of an EHR-generated handoff and rounding list. The quality and quantity of errors were compared pre- and post-EHR-based list implementation. A survey was used to determine time spent by team members using the two versions of the list. Perceived utility, safety, and quality of the list were reported. Serious safety events determined by the hospital were also compared for the two periods. The EHR-based list eliminated clerical errors while improving efficiency by automatically providing data such as vital signs. Survey respondents reported 43 min saved per week per team member, translating to 372 work hours of time saved annually for a single service. EHR-based list users reported higher satisfaction and perceived improvement in efficiency, accuracy, and safety. Serious safety events remained unchanged. In conclusion, creation of an EHR-based list to assist with daily handoffs, rounding, and patient management demonstrated improved accuracy, increased efficiency, and assisted in maintaining a high level of safety. PMID:25631842

  1. Open source electronic health records and chronic disease management

    PubMed Central

    Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

    2014-01-01

    Objective To study and report on the use of open source electronic health records (EHR) to assist with chronic care management within safety net medical settings, such as community health centers (CHC). Methods and Materials The study was conducted by NORC at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to CHC that currently use an open source EHR. Results Two of the sites chosen by NORC were actively using an open source EHR to assist in the redesign of their care delivery system to support more effective chronic disease management. This included incorporating the chronic care model into an CHC and using the EHR to help facilitate its elements, such as care teams for patients, in addition to maintaining health records on indigent populations, such as tuberculosis status on homeless patients. Discussion The ability to modify the open-source EHR to adapt to the CHC environment and leverage the ecosystem of providers and users to assist in this process provided significant advantages in chronic care management. Improvements in diabetes management, controlled hypertension and increases in tuberculosis vaccinations were assisted through the use of these open source systems. Conclusions The flexibility and adaptability of open source EHR demonstrated its utility and viability in the provision of necessary and needed chronic disease care among populations served by CHC. PMID:23813566

  2. Effect of an Electronic Health Record on the Culture of an Outpatient Medical Oncology Practice in a Four-Hospital Integrated Health Care System: 5-Year Experience

    PubMed Central

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

    2011-01-01

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

  3. Electronic Health in Perspective of Healthcare Managers: A Qualitative Study in South of Iran

    PubMed Central

    BASTANI, Peivand; ABOLHASANI, Nazanin; SHAARBAFCHIZADEH, Nasrin

    2014-01-01

    Abstract Background The important role of electronic health as well as importance of health care systems awareness and readiness may lead to develop the essential infrastructures for electronic health especially in developing countries. This study aims to investigate goals, gains, applications, challenges and other important issues related to success performance of electronic health. Method This research proposed a grounded theory in a qualitative design and a purposive sampling was used to select participants which consisted of 28 hospital managers and staff field managers working in deputy of health and curative affairs of Medical Science Universities in south of Iran. Semi structured interviews were conducted using a topic guide and intended themes derived from the results using Max QDA software during five steps. Results Nine themes through interviewees” viewpoints were made up as followed: Electronic health definition, necessity and importance of electronic health, electronic health advantages, relationship between electronic health and internet, physicians” opposition to electronic health, prerequisites for electronic health, solutions for applying electronic health plan, factors affecting electronic health acceptance in society and electronic health system challenges. Conclusion It seems that there are good circumstances in the south medical universities about settlement and implementations of electronic health and their managers are aware of its advantages, importance and necessities. The present findings implicate that these organizations should consider the user friendly and probable resistances of the present clients, in this regard it is suggested that the used technology must be accepted by users, having standard base, inexpensive and simple enough while less vulnerable in response to changes. PMID:26110152

  4. Content barriers to pediatric uptake of electronic health records.

    PubMed

    Gracy, Delaney; Weisman, Jeb; Grant, Roy; Pruitt, Jennifer; Brito, Arturo

    2012-01-01

    EHR systems provide significant opportunities to enhance pediatric care. Well-constructed clinical content, HIE, automated reminders and alerts, and reporting at practice, community, and public health levels are available in several current systems and products. However, the general focus on inpatient and adult populations in the design and marketing of these systems should be seen as a significant barrier to EHR adoption among pediatric primary care providers. Weight-based medication dosing, specialty growth charts, units of measurement and time, and measures to address minor consent and adolescent confidentiality are not universal in quality and availability to the pediatric practice. However, there are opportunities for pediatricians to provide input and to clearly state minimum requirements when dealing with vendors or when government agencies (eg, ONCHIT and AHRQ) seek comment on standards, practices, and expectations. This article uses cases and examples to describe some areas in which pediatricians should take an active role to advocate for pediatric-appropriate EHR tools. Virtually every child born and cared for in the United States today will have their data and information recorded in an EHR. The quality of the information and the HIT in which it is recorded can affect the care they get as children, and the information they carry into adulthood.

  5. Development of an electronic public health case report using HL7 v2.5 to meet public health needs.

    PubMed

    Rajeev, Deepthi; Staes, Catherine J; Evans, R Scott; Mottice, Susan; Rolfs, Robert; Samore, Matthew H; Whitney, Jon; Kurzban, Richard; Huff, Stanley M

    2010-01-01

    Clinicians are required to report selected conditions to public health authorities within a stipulated amount of time. The current reporting process is mostly paper-based and inefficient and may lead to delays in case investigation. As electronic medical records become more prevalent, electronic case reporting is becoming increasingly feasible. However, there is no existing standard for the electronic transmission of case reports from healthcare to public health entities. We identified the major requirements of electronic case reports and verified that the requirements support the work processes of the local health departments. We propose an extendable standards-based model to electronically transmit case information and associated laboratory information from healthcare to public health entities. The HL7 v2.5 message model is currently being implemented to transmit electronic case reports from Intermountain Healthcare to the Utah Department of Health.

  6. Data Quality and Interoperability Challenges for eHealth Exchange Participants: Observations from the Department of Veterans Affairs' Virtual Lifetime Electronic Record Health Pilot Phase.

    PubMed

    Botts, Nathan; Bouhaddou, Omar; Bennett, Jamie; Pan, Eric; Byrne, Colene; Mercincavage, Lauren; Olinger, Lois; Hunolt, Elaine; Cullen, Theresa

    2014-01-01

    Authors studied the United States (U.S.) Department of Veterans Affairs' (VA) Virtual Lifetime Electronic Record (VLER) Health pilot phase relative to two attributes of data quality - the adoption of eHealth Exchange data standards, and clinical content exchanged. The VLER Health pilot was an early effort in testing implementation of eHealth Exchange standards and technology. Testing included evaluation of exchange data from the VLER Health pilot sites partners: VA, U.S. Department of Defense (DoD), and private sector health care organizations. Domains assessed data quality and interoperability as it relates to: 1) conformance with data standards related to the underlying structure of C32 Summary Documents (C32) produced by eHealth Exchange partners; and 2) the types of C32 clinical content exchanged. This analysis identified several standards non-conformance issues in sample C32 files and informed further discourse on the methods needed to effectively monitor Health Information Exchange (HIE) data content and standards conformance.

  7. Mobile health platform for pressure ulcer monitoring with electronic health record integration.

    PubMed

    Rodrigues, Joel J P C; Pedro, Luís M C C; Vardasca, Tomé; de la Torre-Díez, Isabel; Martins, Henrique M G

    2013-12-01

    Pressure ulcers frequently occur in patients with limited mobility, for example, people with advanced age and patients wearing casts or prostheses. Mobile information communication technologies can help implement ulcer care protocols and the monitoring of patients with high risk, thus preventing or improving these conditions. This article presents a mobile pressure ulcer monitoring platform (mULCER), which helps control a patient's ulcer status during all stages of treatment. Beside its stand-alone version, it can be integrated with electronic health record systems as mULCER synchronizes ulcer data with any electronic health record system using HL7 standards. It serves as a tool to integrate nursing care among hospital departments and institutions. mULCER was experimented with in different mobile devices such as LG Optimus One P500, Samsung Galaxy Tab, HTC Magic, Samsung Galaxy S, and Samsung Galaxy i5700, taking into account the user's experience of different screen sizes and processing characteristics.

  8. Integrating research data capture into the electronic health record workflow: real-world experience to advance innovation.

    PubMed

    Laird-Maddox, Marsha; Mitchell, Susan B; Hoffman, Mark

    2014-01-01

    As the adoption of electronic health records (EHRs) increases, more opportunities are available for leveraging the system and the data to facilitate research. Historically, for patients enrolled in clinical research trials or studies, data have been documented in the medical record, and then study-related data are manually reentered into an electronic case report form in a research system. By utilizing data collected in the EHR to prepopulate electronic case report forms, manual transcription is reduced, data quality is improved, and the workflow for capturing research data is streamlined. Past efforts to integrate EHRs and research systems for the purposes of data capture have demonstrated that interoperability is possible. This article highlights how Cerner Corporation and Florida Hospital collaborated to extend an existing standard to implement a workflow called Integrated Data Capture. PMID:25593571

  9. School Health Connection Goes Electronic: Developing a Health Information Management System for New Orleans' School-Based Health Centers. Program Results Report

    ERIC Educational Resources Information Center

    Rastorfer, Darl

    2011-01-01

    From February 2008 through April 2011, School Health Connection, a program of the Louisiana Public Health Institute, developed an electronic health information management system for newly established school-based health centers in Greater New Orleans. School Health Connection was established as part of a broader effort to restore community health…

  10. Leveraging the Cloud for Electronic Health Record Access

    PubMed Central

    Coats, Brian; Acharya, Subrata

    2014-01-01

    Healthcare providers are under increasing pressure to enable widespread access to their electronic health record (EHR) systems for the patients they serve; the meaningful use incentive programs are perhaps the most significant driver encouraging this access. Elsewhere, the cloud has become extremely efficient and successful at establishing digital identities for individuals and making them interoperable across heterogeneous systems. As the healthcare industry contemplates providing patients access to their EHRs, the solution should leverage existing cloud investment, not duplicate it. Through an analysis of industry standards and similar work being performed in other industries, a trust framework has been derived for exchanging identity information. This research lays out a comprehensive structure that healthcare providers can easily use to integrate their EHRs with the cloud for identity validation, while meeting compliance guidelines for security and privacy. Further, this research has been implemented at a large regional hospital, yielding immediate and tangible improvements. PMID:24808814

  11. Leveraging the cloud for electronic health record access.

    PubMed

    Coats, Brian; Acharya, Subrata

    2014-01-01

    Healthcare providers are under increasing pressure to enable widespread access to their electronic health record (EHR) systems for the patients they serve; the meaningful use incentive programs are perhaps the most significant driver encouraging this access. Elsewhere, the cloud has become extremely efficient and successful at establishing digital identities for individuals and making them interoperable across heterogeneous systems. As the healthcare industry contemplates providing patients access to their EHRs, the solution should leverage existing cloud investment, not duplicate it. Through an analysis of industry standards and similar work being performed in other industries, a trust framework has been derived for exchanging identity information. This research lays out a comprehensive structure that healthcare providers can easily use to integrate their EHRs with the cloud for identity validation, while meeting compliance guidelines for security and privacy. Further, this research has been implemented at a large regional hospital, yielding immediate and tangible improvements. PMID:24808814

  12. Electronic health record functionality needed to better support primary care.

    PubMed

    Krist, Alex H; Beasley, John W; Crosson, Jesse C; Kibbe, David C; Klinkman, Michael S; Lehmann, Christoph U; Fox, Chester H; Mitchell, Jason M; Mold, James W; Pace, Wilson D; Peterson, Kevin A; Phillips, Robert L; Post, Robert; Puro, Jon; Raddock, Michael; Simkus, Ray; Waldren, Steven E

    2014-01-01

    Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies. PMID:24431335

  13. Query log analysis of an electronic health record search engine.

    PubMed

    Yang, Lei; Mei, Qiaozhu; Zheng, Kai; Hanauer, David A

    2011-01-01

    We analyzed a longitudinal collection of query logs of a full-text search engine designed to facilitate information retrieval in electronic health records (EHR). The collection, 202,905 queries and 35,928 user sessions recorded over a course of 4 years, represents the information-seeking behavior of 533 medical professionals, including frontline practitioners, coding personnel, patient safety officers, and biomedical researchers for patient data stored in EHR systems. In this paper, we present descriptive statistics of the queries, a categorization of information needs manifested through the queries, as well as temporal patterns of the users' information-seeking behavior. The results suggest that information needs in medical domain are substantially more sophisticated than those that general-purpose web search engines need to accommodate. Therefore, we envision there exists a significant challenge, along with significant opportunities, to provide intelligent query recommendations to facilitate information retrieval in EHR.

  14. Introducing sexual orientation and gender identity into the electronic health record: one academic health center's experience.

    PubMed

    Callahan, Edward J; Sitkin, Nicole; Ton, Hendry; Eidson-Ton, W Suzanne; Weckstein, Julie; Latimore, Darin

    2015-02-01

    Many U.S. populations experience significant health disparities. Increasing health care providers' awareness of and education about sexual orientation (SO) and gender identity (GI) diversity could help reduce health disparities among lesbian, gay, bisexual, and transgender (LGBT) patients. The authors share the University of California, Davis, Health System's (UCDHS's) experience as it became the first U.S. academic health center to formally introduce patient SO/GI demographic data into its electronic health record (EHR) as a step toward reducing LGBT health disparities. Adding these data to the EHR initially met with resistance. The authors, members of the UCDHS Task Force for Inclusion of SO/GI in the EHR, viewed this resistance as an invitation to educate leaders, providers, and staff about LGBT health disparities and to expose providers to techniques for discussing SO/GI with patients. They describe the strategies they employed to effect institutional culture change, including involvement of senior leadership, key informant interviews, educational outreach via grand rounds and resident workshops, and creation of a patient safety net through inviting providers to self-identify as welcoming LGBT patients. The ongoing cultural change process has inspired spin-off projects contributing to an improved climate for LGBT individuals at UCDHS, including an employee organization supporting SO/GI diversity, support for and among LGBT medical learners through events and listservs, development and implementation of an LGBT health curriculum, and creation of peer navigator programs for LGBT patients with cancer. The authors reflect on lessons learned and on institutional pride in and commitment to providing quality care for LGBT patients.

  15. Introducing sexual orientation and gender identity into the electronic health record: one academic health center's experience.

    PubMed

    Callahan, Edward J; Sitkin, Nicole; Ton, Hendry; Eidson-Ton, W Suzanne; Weckstein, Julie; Latimore, Darin

    2015-02-01

    Many U.S. populations experience significant health disparities. Increasing health care providers' awareness of and education about sexual orientation (SO) and gender identity (GI) diversity could help reduce health disparities among lesbian, gay, bisexual, and transgender (LGBT) patients. The authors share the University of California, Davis, Health System's (UCDHS's) experience as it became the first U.S. academic health center to formally introduce patient SO/GI demographic data into its electronic health record (EHR) as a step toward reducing LGBT health disparities. Adding these data to the EHR initially met with resistance. The authors, members of the UCDHS Task Force for Inclusion of SO/GI in the EHR, viewed this resistance as an invitation to educate leaders, providers, and staff about LGBT health disparities and to expose providers to techniques for discussing SO/GI with patients. They describe the strategies they employed to effect institutional culture change, including involvement of senior leadership, key informant interviews, educational outreach via grand rounds and resident workshops, and creation of a patient safety net through inviting providers to self-identify as welcoming LGBT patients. The ongoing cultural change process has inspired spin-off projects contributing to an improved climate for LGBT individuals at UCDHS, including an employee organization supporting SO/GI diversity, support for and among LGBT medical learners through events and listservs, development and implementation of an LGBT health curriculum, and creation of peer navigator programs for LGBT patients with cancer. The authors reflect on lessons learned and on institutional pride in and commitment to providing quality care for LGBT patients. PMID:25162618

  16. Electronic Health Records Data and Metadata: Challenges for Big Data in the United States.

    PubMed

    Sweet, Lauren E; Moulaison, Heather Lea

    2013-12-01

    This article, written by researchers studying metadata and standards, represents a fresh perspective on the challenges of electronic health records (EHRs) and serves as a primer for big data researchers new to health-related issues. Primarily, we argue for the importance of the systematic adoption of standards in EHR data and metadata as a way of promoting big data research and benefiting patients. EHRs have the potential to include a vast amount of longitudinal health data, and metadata provides the formal structures to govern that data. In the United States, electronic medical records (EMRs) are part of the larger EHR. EHR data is submitted by a variety of clinical data providers and potentially by the patients themselves. Because data input practices are not necessarily standardized, and because of the multiplicity of current standards, basic interoperability in EHRs is hindered. Some of the issues with EHR interoperability stem from the complexities of the data they include, which can be both structured and unstructured. A number of controlled vocabularies are available to data providers. The continuity of care document standard will provide interoperability in the United States between the EMR and the larger EHR, potentially making data input by providers directly available to other providers. The data involved is nonetheless messy. In particular, the use of competing vocabularies such as the Systematized Nomenclature of Medicine-Clinical Terms, MEDCIN, and locally created vocabularies inhibits large-scale interoperability for structured portions of the records, and unstructured portions, although potentially not machine readable, remain essential. Once EMRs for patients are brought together as EHRs, the EHRs must be managed and stored. Adequate documentation should be created and maintained to assure the secure and accurate use of EHR data. There are currently a few notable international standards initiatives for EHRs. Organizations such as Health Level Seven

  17. Electronic Health Records Data and Metadata: Challenges for Big Data in the United States.

    PubMed

    Sweet, Lauren E; Moulaison, Heather Lea

    2013-12-01

    This article, written by researchers studying metadata and standards, represents a fresh perspective on the challenges of electronic health records (EHRs) and serves as a primer for big data researchers new to health-related issues. Primarily, we argue for the importance of the systematic adoption of standards in EHR data and metadata as a way of promoting big data research and benefiting patients. EHRs have the potential to include a vast amount of longitudinal health data, and metadata provides the formal structures to govern that data. In the United States, electronic medical records (EMRs) are part of the larger EHR. EHR data is submitted by a variety of clinical data providers and potentially by the patients themselves. Because data input practices are not necessarily standardized, and because of the multiplicity of current standards, basic interoperability in EHRs is hindered. Some of the issues with EHR interoperability stem from the complexities of the data they include, which can be both structured and unstructured. A number of controlled vocabularies are available to data providers. The continuity of care document standard will provide interoperability in the United States between the EMR and the larger EHR, potentially making data input by providers directly available to other providers. The data involved is nonetheless messy. In particular, the use of competing vocabularies such as the Systematized Nomenclature of Medicine-Clinical Terms, MEDCIN, and locally created vocabularies inhibits large-scale interoperability for structured portions of the records, and unstructured portions, although potentially not machine readable, remain essential. Once EMRs for patients are brought together as EHRs, the EHRs must be managed and stored. Adequate documentation should be created and maintained to assure the secure and accurate use of EHR data. There are currently a few notable international standards initiatives for EHRs. Organizations such as Health Level Seven

  18. A primer for health care managers: data sanitization, equipment disposal, and electronic waste.

    PubMed

    Andersen, Cathy M

    2011-01-01

    In this article, security regulations under the Health Insurance Portability and Accountability Act concerning data sanitization and the disposal of media containing stored electronic protected health information are discussed, and methods for effective sanitization and media disposal are presented. When disposing of electronic media, electronic waste-or e-waste-is produced. Electronic waste can harm human health and the environment. Responsible equipment disposal methods can minimize the impact of e-waste. Examples of how health care organizations can meet the Health Insurance Portability and Accountability Act regulations while also behaving responsibly toward the environment are provided. Examples include the environmental stewardship activities of reduce, reuse, reeducate, recover, and recycle.

  19. Advancing cognitive engineering methods to support user interface design for electronic health records

    PubMed Central

    Thyvalikakath, Thankam P.; Dziabiak, Michael P.; Johnson, Raymond; Torres-Urquidy, Miguel Humberto; Acharya, Amit; Yabes, Jonathan; Schleyer, Titus K.

    2014-01-01

    Background Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. Objective In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. Methods We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. Results Dentists first reviewed the patient’s demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient’s intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient’s information and additional information needs during a typical clinician-patient encounter. Conclusion This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will

  20. Conflict and Compromise in Public Health Policy: Analysis of Changes Made to Five Competitive Food Legislative Proposals Prior to Adoption

    ERIC Educational Resources Information Center

    Dinour, Lauren M.

    2015-01-01

    Competitive foods in schools have historically been scrutinized for their ubiquity and poor nutritional quality, leading many states to enact legislation limiting the availability and accessibility of these items. Evaluations of these policy approaches show their promise in improving the healthfulness of school food environments, considered an…

  1. Code Status and Resuscitation Options in the Electronic Health Record

    PubMed Central

    Bhatia, Haresh L.; Patel, Neal R.; Choma, Neesha N.; Grande, Jonathan; Giuse, Dario A.; Lehmann, Christoph U.

    2014-01-01

    Aim The advance discussion and documentation of code-status is important in preventing undesired cardiopulmonary resuscitation and related End of Life interventions. Code-status documentation remains infrequent and paper-based, which limits its usefulness. This study evaluates a tool to document code-status in the electronic health records at a large teaching hospital, and analyzes the corresponding data. Methods Encounter data for patients admitted to the Medical Center were collected over a period of 12 months (01-APR-2012 – 31-MAR-2013) and the code-status attribute was tracked for individual patients. The code-status data were analyzed separately for adult and pediatric patient populations. We considered 131,399 encounters for 83,248 adult patients and 80,778 encounters for 55,656 pediatric patients in this study. Results 71% of the adult patients and 30% of the pediatric patients studied had a documented code-status. Age and severity of illness influenced the decision to document code-status. Demographics such as gender, race, ethnicity, and proximity of primary residence were also associated with the documentation of code-status. Conclusion Absence of a recorded code-status may result in unnecessary interventions. Code-status in paper charts may be difficult to access in cardiopulmonary arrest situations and may result in unnecessary and unwanted interventions and procedures. Documentation of Code-status in electronic records creates a readily available reference for care providers. PMID:25447035

  2. Psychiatry and the meaningful use of electronic health records.

    PubMed

    Triplett, Patrick

    2013-01-01

    Use of electronic health records (EHRs) for psychiatric care is on the rise, although the software and the workflow patterns on which the software has been built are often based on non-psychiatric practices. For providers, the transition from paper psychiatric records to electronic ones requires the development of a new set of skills that includes accommodating the physical presence of the computer and performing various forms of data entry, while still managing to carry out the tasks required for psychiatric practice. These changes alter the dynamic of communication, including elements of assessment and treatment that occur between the psychiatrist and patient. EHRs also raise issues of security of records and greater access by patients to providers and their records. Although EHRs promise an abundance of useful data for research and potentially helpful innovations, they also impose a practice pattern on psychiatry that is made to work largely through the efforts of the physician. EHRs do not enhance interactions in the psychiatric examination room, but instead alter the traditional pattern on which the doctor-patient relationship is founded in psychiatry and through which care is delivered.

  3. An electronic health record-enabled obesity database

    PubMed Central

    2012-01-01

    Background The effectiveness of weight loss therapies is commonly measured using body mass index and other obesity-related variables. Although these data are often stored in electronic health records (EHRs) and potentially very accessible, few studies on obesity and weight loss have used data derived from EHRs. We developed processes for obtaining data from the EHR in order to construct a database on patients undergoing Roux-en-Y gastric bypass (RYGB) surgery. Methods Clinical data obtained as part of standard of care in a bariatric surgery program at an integrated health delivery system were extracted from the EHR and deposited into a data warehouse. Data files were extracted, cleaned, and stored in research datasets. To illustrate the utility of the data, Kaplan-Meier analysis was used to estimate length of post-operative follow-up. Results Demographic, laboratory, medication, co-morbidity, and survey data were obtained from 2028 patients who had undergone RYGB at the same institution since 2004. Pre-and post-operative diagnostic and prescribing information were available on all patients, while survey laboratory data were available on a majority of patients. The number of patients with post-operative laboratory test results varied by test. Based on Kaplan-Meier estimates, over 74% of patients had post-operative weight data available at 4 years. Conclusion A variety of EHR-derived data related to obesity can be efficiently obtained and used to study important outcomes following RYGB. PMID:22640398

  4. Electronic health records: new opportunities for clinical research.

    PubMed

    Coorevits, P; Sundgren, M; Klein, G O; Bahr, A; Claerhout, B; Daniel, C; Dugas, M; Dupont, D; Schmidt, A; Singleton, P; De Moor, G; Kalra, D

    2013-12-01

    Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources. PMID:23952476

  5. 75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-13

    ... Register (65 FR 50312) entitled ``Health Insurance Reform: Standards for Electronic Transactions... the Federal Register (73 FR 49742) entitled ``Health Insurance Reform: Modifications to Electronic... January 16, 2009, we published a final rule in the Federal Register (74 FR 3296) entitled Health...

  6. Adoption and Use of Internet Technologies in Health Communication: Examining Disparities in Diffusion Patterns, Health Information Sources, and Patient-Provider Encounters

    ERIC Educational Resources Information Center

    Massey, Philip Minter

    2013-01-01

    This dissertation examines the impact of internet technologies on the field of health communication. Access and use of health communication technologies has and will continue to become increasingly important to manage and treat chronic conditions and other ailments, particularly in the context of health care reform that promotes improved quality…

  7. 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Final rule.

    PubMed

    2015-10-16

    This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or "2015 Edition'') and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2015 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology (CEHRT) would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) under the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) when such edition is required for use under these programs.

  8. Nuclear receptor function in skin health and disease: therapeutic opportunities in the orphan and adopted receptor classes.

    PubMed

    Yin, Kelvin; Smith, Aaron G

    2016-10-01

    The skin forms a vital barrier between an organism's external environment, providing protection from pathogens and numerous physical and chemical threats. Moreover, the intact barrier is essential to prevent water and electrolyte loss without which terrestrial life could not be maintained. Accordingly, acute disruption of the skin through physical or chemical trauma needs to be repaired timely and efficiently as sustained skin pathologies ranging from mild irritations and inflammation through to malignancy impact considerably on morbidity and mortality. The Nuclear Hormone Receptor Family of transcriptional regulators has proven to be highly valuable targets for addressing a range of pathologies, including metabolic syndrome and cancer. Indeed members of the classic endocrine sub-group, such as the glucocorticoid, retinoid, and Vitamin D receptors, represent mainstay treatment strategies for numerous inflammatory skin disorders, though side effects from prolonged use are common. Emerging evidence has now highlighted important functional roles for nuclear receptors belonging to the adopted and orphan subgroups in skin physiology and patho-physiology. This review will focus on these subgroups and explore the current evidence that suggests these nuclear receptor hold great promise as future stand-alone or complementary drug targets in treating common skin diseases and maintaining skin homeostasis. PMID:27544210

  9. Nuclear receptor function in skin health and disease: therapeutic opportunities in the orphan and adopted receptor classes.

    PubMed

    Yin, Kelvin; Smith, Aaron G

    2016-10-01

    The skin forms a vital barrier between an organism's external environment, providing protection from pathogens and numerous physical and chemical threats. Moreover, the intact barrier is essential to prevent water and electrolyte loss without which terrestrial life could not be maintained. Accordingly, acute disruption of the skin through physical or chemical trauma needs to be repaired timely and efficiently as sustained skin pathologies ranging from mild irritations and inflammation through to malignancy impact considerably on morbidity and mortality. The Nuclear Hormone Receptor Family of transcriptional regulators has proven to be highly valuable targets for addressing a range of pathologies, including metabolic syndrome and cancer. Indeed members of the classic endocrine sub-group, such as the glucocorticoid, retinoid, and Vitamin D receptors, represent mainstay treatment strategies for numerous inflammatory skin disorders, though side effects from prolonged use are common. Emerging evidence has now highlighted important functional roles for nuclear receptors belonging to the adopted and orphan subgroups in skin physiology and patho-physiology. This review will focus on these subgroups and explore the current evidence that suggests these nuclear receptor hold great promise as future stand-alone or complementary drug targets in treating common skin diseases and maintaining skin homeostasis.

  10. Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors.

    PubMed

    Ratwani, Raj M; Fairbanks, Rollin J; Hettinger, A Zachary; Benda, Natalie C

    2015-11-01

    The usability of electronic health records (EHRs) continues to be a point of dissatisfaction for providers, despite certification requirements from the Office of the National Coordinator that require EHR vendors to employ a user-centered design (UCD) process. To better understand factors that contribute to poor usability, a research team visited 11 different EHR vendors in order to analyze their UCD processes and discover the specific challenges that vendors faced as they sought to integrate UCD with their EHR development. Our analysis demonstrates a diverse range of vendors' UCD practices that fall into 3 categories: well-developed UCD, basic UCD, and misconceptions of UCD. Specific challenges to practicing UCD include conducting contextually rich studies of clinical workflow, recruiting participants for usability studies, and having support from leadership within the vendor organization. The results of the study provide novel insights for how to improve usability practices of EHR vendors.

  11. Introducing vouchers for malaria prevention in Ghana and Tanzania: context and adoption of innovation in health systems.

    PubMed

    de Savigny, Don; Webster, Jayne; Agyepong, Irene Akua; Mwita, Alex; Bart-Plange, Constance; Baffoe-Wilmot, Aba; Koenker, Hannah; Kramer, Karen; Brown, Nick; Lengeler, Christian

    2012-10-01

    There are striking similarities in health system and other contexts between Tanzania and Ghana that are relevant to the scaling up of continuous delivery of insecticide treated nets (ITNs) for malaria prevention. However, specific contextual factors of relevance to ITN delivery have led implementation down very different pathways in the two countries. Both countries have made major efforts and investments to address this intervention through integrating consumer discount vouchers into the health system. Discount vouchers require arrangements among the public, private and non-governmental sectors and constitute a complex intervention in both health systems and business systems. In Tanzania, vouchers have moved beyond the planning agenda, had policies and programmes formulated, been sustained in implementation at national scale for many years and have become as of 2012 the main and only publicly supported continuous delivery system for ITNs. In Ghana national-scale implementation of vouchers never progressed beyond consideration on the agenda and piloting towards formulation of policy; and the approach was replaced by mass distribution campaigns with less dependency on or integration with the health system. By 2011, Ghana entered a phase with no publicly supported continuous delivery system for ITNs. To understand the different outcomes, we compared the voucher programme timelines, phases, processes and contexts in both countries in reference to the main health system building blocks (governance, human resources, financing, informatics, technologies and service delivery). Contextual factors which provided an enabling environment for the voucher scheme in Tanzania did not do so in Ghana. The voucher scheme was never seen as an appropriate national strategy, other delivery systems were not complementary and the private sector was under-developed. The extensive time devoted to engagement and consensus building among all stakeholders in Tanzania was an important and

  12. Some correlates of electronic health information management system success in nigerian teaching hospitals.

    PubMed

    Ojo, Adebowale I; Popoola, Sunday O

    2015-01-01

    Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS's success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals. PMID:25983557

  13. Some Correlates of Electronic Health Information Management System Success in Nigerian Teaching Hospitals

    PubMed Central

    Ojo, Adebowale I; Popoola, Sunday O

    2015-01-01

    Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS’s success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals. PMID:25983557

  14. Electronic Health Record (EHR) As a Vehicle for Successful Health Care Best Practice

    PubMed Central

    Ghazisaeedi, Marjan; Mohammadzadeh, Niloofar; Safdari, Reza

    2014-01-01

    Objective: application of EHR in journey toward the development and adaptation of best practice approach in health care has particular importance. The aim of this review article is survey of successful best practice through EHR. Methods: In this literature review articles were searched with keywords like Electronic Health Record, Best Practice in Science Direct, Google Scholar and Pub Med databases since 1999. Results: best practice in health care through some services like utilization management, case management, and information technology tools can perform. Utilization management in combination with evidence based medicine facilitate determine best decision. Health records are based on evidence medicine and be the richest source of health information. Definitely use of EHR has play pivotal role in journey toward the development and adaptation of best practice approach. Conclusion: Because of potential capabilities, EHR can be regarded as a main core and fundamental element in best practice approach. Success implementation of EHR relies on many factors that should be considered. Some critical success factors for EHR implementation that should be noted are change management, Physicians, nurses and key stakeholders involvement, leadership, provide reliable information technology infrastructure, system design, privacy and security, right budget, support high level management, clear communicate, determine goals and user needs, and define roles and responsibilities, interoperability standards. PMID:25648601

  15. Health behavior modification after electron beam computed tomography and physician consultation.

    PubMed

    Schwartz, Jennifer; Allison, Mathew; Wright, C Michael

    2011-04-01

    This study aimed to determine whether participants reported altering health behaviors (physical activity, diet, and alcohol consumption) after seeing results from an electron-beam computed tomography (EBCT) scan for coronary artery calcium and reviewing these results with a physician. Clinicians attempt to motivate patients to control cardiovascular risk factors by adopting healthy behaviors and reducing harmful actions. Asymptomatic patients (N = 510) were evaluated by EBCT for the extent of coronary artery calcium. Information pertaining to demographics, health history, and lifestyle/health behaviors was obtained from each participant at the time of the EBCT scan. Patients were given their numerical calcium score, shown images of their coronary arteries, and counseled by a physician for lifestyle and medical risk modification based on their coronary artery calcium score. Approximately 6 years after the scan, participants completed a follow-up questionnaire related to lifestyle modifications. In multivariable analysis, the presence and extent of coronary artery calcium was significantly associated with beneficial health behavior modifications. Specifically, the greater a patient's coronary artery calcium score, the more likely they were to report increasing exercise (odds ratio = 1.34, P = 0.02), changing diet (odds ratio = 1.40, P < 0.01), and changing alcohol intake (odds ratio = 1.46, P = 0.05). This study suggests that seeing and being counseled on the presence and extent of coronary artery calcium is significantly associated with behavior change. PMID:20857186

  16. Exploring electronic health records as a population health surveillance tool of cardiovascular disease risk factors.

    PubMed

    Sidebottom, Abbey C; Johnson, Pamela Jo; VanWormer, Jeffrey J; Sillah, Arthur; Winden, Tamara J; Boucher, Jackie L

    2015-04-01

    The objective of this study was to examine the utility of using electronic health record (EHR) data for periodic community health surveillance of cardiovascular disease (CVD) risk factors through 2 research questions. First, how many years of EHR data are needed to produce reliable estimates of key population-level CVD health indicators for a community? Second, how comparable are the EHR estimates relative to those from community screenings? The study takes place in the context of the Heart of New Ulm Project, a 10-year population health initiative designed to reduce myocardial infarctions and CVD risk factor burden in a rural community. The community is served by 1 medical center that includes a clinic and hospital. The project screened adult residents of New Ulm for CVD risk factors in 2009. EHR data for 3 years prior to the heart health screenings were extracted for patients from the community. Single- and multiple-year EHR prevalence estimates were compared for individuals ages 40-79 years (N=5918). EHR estimates also were compared to screening estimates (N=3123). Single-year compared with multiyear EHR data prevalence estimates were sufficiently precise for this rural community. EHR and screening prevalence estimates differed significantly-systolic blood pressure (BP) (124.0 vs. 128.9), diastolic BP (73.3 vs. 79.2), total cholesterol (186.0 vs. 201.0), body mass index (30.2 vs. 29.5), and smoking (16.6% vs. 8.2%)-suggesting some selection bias depending on the method used. Despite differences between data sources, EHR data may be a useful source of population health surveillance to inform and evaluate local population health initiatives.

  17. Can an electronic health record system be used for preconception health optimization?

    PubMed

    Straub, Heather; Adams, Marci; Silver, Richard K

    2014-11-01

    To explore the potential of an integrated outpatient electronic health record (EHR) for preconception health optimization. An automated case-finding EHR-derived algorithm was designed to identify women of child-bearing age having outpatient encounters in an 85-site, integrated health system. The algorithm simultaneously cross-referenced multiple discrete data fields to identify selected preconception factors (obesity, hypertension, diabetes, teratogen use including ACE inhibitors, multivitamin supplementation, anemia, renal insufficiency, untreated sexually transmitted infection, HIV positivity, and tobacco, alcohol or illegal drug use). Surveys were mailed to a random sample of patients to obtain their self-reported health profiles for these same factors. Concordance was assessed between the algorithm output, survey results, and manual data abstraction. Between 8/2010-2/2012, 107,339 female outpatient visits were identified, from which 29,691 unique women were presumed to have child-bearing potential. 19,624 (66 %) and 8,652 (29 %) had 1 or ≥2 health factors, respectively while only 1,415 (5 %) had none. Using the patient survey results as a reference point, health-factor agreement was similar comparing the algorithm (85.8 %) and the chart abstraction (87.2 %) results. Incorrect or missing data entries in the EHR encounters were largely responsible for discordances observed. Preconception screening using an automated algorithm in a system-wide EHR identified a large group of women with potentially modifiable preconception health conditions. The issue most responsible for limiting algorithm performance was incomplete point of care documentation. Accurate data capture during patient encounters should be a focus for quality improvement, so that novel applications of system-wide data mining can be reliably implemented. PMID:24627232

  18. Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users

    PubMed Central

    Pajunen, Tuuli; Saranto, Kaija; Lehtonen, Lasse

    2016-01-01

    Background The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system. Objective This study addresses two important questions: (1) “which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users?”, and (2) “which variables are associated with high- and extreme-risk severity ratings?” Methods This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach’s alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined. Results A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type “extended EHR unavailability”. The lowest overall risk level was associated with “selecting incorrectly from a list of items”. In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest (P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels (P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors. Conclusions Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should

  19. 45 CFR 1355.40 - Foster care and adoption data collection.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL... electronically report certain data regarding children in foster care and adoption. The foster care data...

  20. Electronic health records and support for primary care teamwork

    PubMed Central

    Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A.; Scholle, Sarah Hudson

    2015-01-01

    Objective Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Methods Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. Results EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Discussion Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. Conclusions EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. PMID:25627278

  1. Designing a quality improvement program with electronic health records: New York City's Health eQuits.

    PubMed

    Duquaine, Damon; Farley, Shannon M; Sacks, Rachel; Mandel-Ricci, Jenna; Silfen, Sheryl L; Shih, Sarah C

    2015-01-01

    Despite clear recommendations for identifying and intervening with smokers, clinical preventive practice is inconsistent in primary care. Use of electronic health records could facilitate improvement. Community health centers treating low-income and Medicaid recipients with greater smoking prevalence than the general population were recruited for a pilot program. Key design elements used to engage centers' participation include designating a project champion at each organization, confirming ability to transmit data for reporting and participation, and offering money to facilitate initial engagement; however, financial incentives did not motivate all organizations. Other methods to elicit participation and to motivate practice change included building on centers' previous experiences with similar programs, utilizing existing relationships with state cessation centers, and harnessing the "competitive" spirit-sharing both good news and areas for improvement to stimulate action. These experiences and observations may assist others in designing programs to improve clinical interventions with smokers.

  2. Using Digital Crumbs from an Electronic Health Record to Identify, Study and Improve Health Care Teams

    PubMed Central

    Gray, James E; Feldman, Henry; Reti, Shane; Markson, Larry; Lu, Xiaoning; Davis, Roger B.; Safran, Charles A

    2011-01-01

    We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails. We believe that by applying the methods of social networking to define clinical relationships around a patient’s care we will enable new areas of research into the usage of EHRs to promote patient safety and other improvements in care. PMID:22195103

  3. Using Digital Crumbs from an Electronic Health Record to identify, study and improve health care teams.

    PubMed

    Gray, James E; Feldman, Henry; Reti, Shane; Markson, Larry; Lu, Xiaoning; Davis, Roger B; Safran, Charles A

    2011-01-01

    We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails. We believe that by applying the methods of social networking to define clinical relationships around a patient's care we will enable new areas of research into the usage of EHRs to promote patient safety and other improvements in care.

  4. Learning Relational Policies from Electronic Health Record Access Logs

    PubMed Central

    Malin, Bradley; Nyemba, Steve; Paulett, John

    2011-01-01

    Modern healthcare organizations (HCOs) are composed of complex dynamic teams to ensure clinical operations are executed in a quick and competent manner. At the same time, the fluid nature of such environments hinders administrators' efforts to define access control policies that appropriately balance patient privacy and healthcare functions. Manual efforts to define these policies are labor-intensive and error-prone, often resulting in systems that endow certain care providers with overly broad access to patients' medical records while restricting other providers from legitimate and timely use. In this work, we propose an alternative method to generate these policies by automatically mining usage patterns from electronic health record (EHR) systems. EHR systems are increasingly being integrated into clinical environments and our approach is designed to be generalizable across HCOs, thus assisting in the design and evaluation of local access control policies. Our technique, which is grounded in data mining and social network analysis theory, extracts a statistical model of the organization from the access logs of its EHRs. In doing so, our approach enables the review of predefined policies, as well as the discovery of unknown behaviors. We evaluate our approach with five months of access logs from the Vanderbilt University Medical Center and confirm the existence of stable social structures and intuitive business operations. Additionally, we demonstrate that there is significant turnover in the interactions between users in the HCO and that policies learned at the department level afford greater stability over time. PMID:21277996

  5. CADe System Integrated within the Electronic Health Record

    PubMed Central

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

    2013-01-01

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

  6. Home telemental health implementation and outcomes using electronic messaging.

    PubMed

    Godleski, Linda; Cervone, Dana; Vogel, Donna; Rooney, Meghan

    2012-01-01

    In 2007, the VA Connecticut Healthcare System began a home electronic messaging programme for mental health patients. During the first two years, 76 patients with diagnoses of schizophrenia, post traumatic stress disorder, depression and substance-use disorders received a home messaging device, which was connected via an ordinary telephone line. There were daily questions, which were based on disease management protocols, and included alerts, data and educational components. Patient data were sent to a nurse practitioner each day for triage and follow-up. Patients used the device for at least six months. In the six months prior to enrolment, 42 patients were hospitalized for 46 admissions. In the following six months, six patients were hospitalized for nine admissions (P < 0.0001). In the six months prior to enrolment, 47 patients had a total of 80 ER visits. In the following six months, 16 patients had a total of 32 ER visits (P < 0.0001). Questionnaire responses indicated a high level of satisfaction with the home messaging programme.

  7. Clinical Research Informatics and Electronic Health Record Data

    PubMed Central

    Horvath, M. M.; Rusincovitch, S. A.

    2014-01-01

    Summary Objectives The goal of this survey is to discuss the impact of the growing availability of electronic health record (EHR) data on the evolving field of Clinical Research Informatics (CRI), which is the union of biomedical research and informatics. Results Major challenges for the use of EHR-derived data for research include the lack of standard methods for ensuring that data quality, completeness, and provenance are sufficient to assess the appropriateness of its use for research. Areas that need continued emphasis include methods for integrating data from heterogeneous sources, guidelines (including explicit phenotype definitions) for using these data in both pragmatic clinical trials and observational investigations, strong data governance to better understand and control quality of enterprise data, and promotion of national standards for representing and using clinical data. Conclusions The use of EHR data has become a priority in CRI. Awareness of underlying clinical data collection processes will be essential in order to leverage these data for clinical research and patient care, and will require multi-disciplinary teams representing clinical research, informatics, and healthcare operations. Considerations for the use of EHR data provide a starting point for practical applications and a CRI research agenda, which will be facilitated by CRI’s key role in the infrastructure of a learning healthcare system. PMID:25123746

  8. Detecting Inappropriate Access to Electronic Health Records Using Collaborative Filtering

    PubMed Central

    Menon, Aditya Krishna; Jiang, Xiaoqian; Kim, Jihoon; Vaidya, Jaideep; Ohno-Machado, Lucila

    2013-01-01

    Many healthcare facilities enforce security on their electronic health records (EHRs) through a corrective mechanism: some staff nominally have almost unrestricted access to the records, but there is a strict ex post facto audit process for inappropriate accesses, i.e., accesses that violate the facility’s security and privacy policies. This process is inefficient, as each suspicious access has to be reviewed by a security expert, and is purely retrospective, as it occurs after damage may have been incurred. This motivates automated approaches based on machine learning using historical data. Previous attempts at such a system have successfully applied supervised learning models to this end, such as SVMs and logistic regression. While providing benefits over manual auditing, these approaches ignore the identity of the users and patients involved in a record access. Therefore, they cannot exploit the fact that a patient whose record was previously involved in a violation has an increased risk of being involved in a future violation. Motivated by this, in this paper, we propose a collaborative filtering inspired approach to predicting inappropriate accesses. Our solution integrates both explicit and latent features for staff and patients, the latter acting as a personalized “finger-print” based on historical access patterns. The proposed method, when applied to real EHR access data from two tertiary hospitals and a file-access dataset from Amazon, shows not only significantly improved performance compared to existing methods, but also provides insights as to what indicates an inappropriate access. PMID:24683293

  9. Measuring Nursing Value from the Electronic Health Record.

    PubMed

    Welton, John M; Harper, Ellen M

    2016-01-01

    We report the findings of a big data nursing value expert group made up of 14 members of the nursing informatics, leadership, academic and research communities within the United States tasked with 1. Defining nursing value, 2. Developing a common data model and metrics for nursing care value, and 3. Developing nursing business intelligence tools using the nursing value data set. This work is a component of the Big Data and Nursing Knowledge Development conference series sponsored by the University Of Minnesota School Of Nursing. The panel met by conference calls for fourteen 1.5 hour sessions for a total of 21 total hours of interaction from August 2014 through May 2015. Primary deliverables from the bit data expert group were: development and publication of definitions and metrics for nursing value; construction of a common data model to extract key data from electronic health records; and measures of nursing costs and finance to provide a basis for developing nursing business intelligence and analysis systems. PMID:27332163

  10. Information Discovery on Electronic Health Records Using Authority Flow Techniques

    PubMed Central

    2010-01-01

    Background As the use of electronic health records (EHRs) becomes more widespread, so does the need to search and provide effective information discovery within them. Querying by keyword has emerged as one of the most effective paradigms for searching. Most work in this area is based on traditional Information Retrieval (IR) techniques, where each document is compared individually against the query. We compare the effectiveness of two fundamentally different techniques for keyword search of EHRs. Methods We built two ranking systems. The traditional BM25 system exploits the EHRs' content without regard to association among entities within. The Clinical ObjectRank (CO) system exploits the entities' associations in EHRs using an authority-flow algorithm to discover the most relevant entities. BM25 and CO were deployed on an EHR dataset of the cardiovascular division of Miami Children's Hospital. Using sequences of keywords as queries, sensitivity and specificity were measured by two physicians for a set of 11 queries related to congenital cardiac disease. Results Our pilot evaluation showed that CO outperforms BM25 in terms of sensitivity (65% vs. 38%) by 71% on average, while maintaining the specificity (64% vs. 61%). The evaluation was done by two physicians. Conclusions Authority-flow techniques can greatly improve the detection of relevant information in EHRs and hence deserve further study. PMID:20969780

  11. CADe system integrated within the electronic health record.

    PubMed

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

    2013-01-01

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

  12. An electronic consumer health library: NetWellness.

    PubMed Central

    Guard, R; Haag, D; Kaya, B; Marine, S; Morris, T; Schick, L; Shoemaker, S

    1996-01-01

    NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org. PMID:8913548

  13. Automated methods for the summarization of electronic health records

    PubMed Central

    Elhadad, Noémie

    2015-01-01

    Objectives This review examines work on automated summarization of electronic health record (EHR) data and in particular, individual patient record summarization. We organize the published research and highlight methodological challenges in the area of EHR summarization implementation. Target audience The target audience for this review includes researchers, designers, and informaticians who are concerned about the problem of information overload in the clinical setting as well as both users and developers of clinical summarization systems. Scope Automated summarization has been a long-studied subject in the fields of natural language processing and human–computer interaction, but the translation of summarization and visualization methods to the complexity of the clinical workflow is slow moving. We assess work in aggregating and visualizing patient information with a particular focus on methods for detecting and removing redundancy, describing temporality, determining salience, accounting for missing data, and taking advantage of encoded clinical knowledge. We identify and discuss open challenges critical to the implementation and use of robust EHR summarization systems. PMID:25882031

  14. Consensus Statement on Electronic Health Predictive Analytics: A Guiding Framework to Address Challenges

    PubMed Central

    Amarasingham, Ruben; Audet, Anne-Marie J.; Bates, David W.; Glenn Cohen, I.; Entwistle, Martin; Escobar, G. J.; Liu, Vincent; Etheredge, Lynn; Lo, Bernard; Ohno-Machado, Lucila; Ram, Sudha; Saria, Suchi; Schilling, Lisa M.; Shahi, Anand; Stewart, Walter F.; Steyerberg, Ewout W.; Xie, Bin

    2016-01-01

    Context: The recent explosion in available electronic health record (EHR) data is motivating a rapid expansion of electronic health care predictive analytic (e-HPA) applications, defined as the use of electronic algorithms that forecast clinical events in real time with the intent to improve patient outcomes and reduce costs. There is an urgent need for a systematic framework to guide the development and application of e-HPA to ensure that the field develops in a scientifically sound, ethical, and efficient manner. Objectives: Building upon earlier frameworks of model development and utilization, we identify the emerging opportunities and challenges of e-HPA, propose a framework that enables us to realize these opportunities, address these challenges, and motivate e-HPA stakeholders to both adopt and continuously refine the framework as the applications of e-HPA emerge. Methods: To achieve these objectives, 17 experts with diverse expertise including methodology, ethics, legal, regulation, and health care delivery systems were assembled to identify emerging opportunities and challenges of e-HPA and to propose a framework to guide the development and application of e-HPA. Findings: The framework proposed by the panel includes three key domains where e-HPA differs qualitatively from earlier generations of models and algorithms (Data Barriers, Transparency, and Ethics) and areas where current frameworks are insufficient to address the emerging opportunities and challenges of e-HPA (Regulation and Certification; and Education and Training). The following list of recommendations summarizes the key points of the framework: Data Barriers: Establish mechanisms within the scientific community to support data sharing for predictive model development and testing.Transparency: Set standards around e-HPA validation based on principles of scientific transparency and reproducibility.Ethics: Develop both individual-centered and society-centered risk-benefit approaches to evaluate

  15. Evaluation of the Impact of Different Types of Health Education on the Adoption and Preservation of Prohealth Attitudes in Preventing Cancer in Juveniles Younger than 18 Years.

    PubMed

    Adamowicz, Krzysztof; Zalewska, Marta; Majkowicz, Mikołaj; Zaucha, Jan Maciej

    2015-09-01

    Reduction in the incidence of cancer can be achieved through appropriate health behaviors. We hypothesized that education would improve knowledge of cancer prevention, and this, in turn, will affect and individual's readiness to modify lifestyle. The aim of this study was to assess the impact of cancer prevention education on adopting and preserving prohealth attitudes among high school students in Poland. Research participants were 307 high school students varying by gender, place of residence, parents' education, and type of school education. Participants were divided into five groups, of which four were educated using different methods according to classification methods based on the concept of multilateral learning. The fifth (control) group was not educated. The effects of education were assessed 1 month and 1 year after education. General knowledge about cancer and healthy lifestyle level before education was low. After education, both increased compared with the control group. There was a clear relationship between level of knowledge and readiness to adopt and healthy attitudes and behavior. The most effective method of education was a discussion and a lecture by means of teaching complex. Education significantly improved generally low knowledge about cancer and healthy lifestyle in high school students. This indicates the urgent need to implement such educational programs.

  16. Adoption: medical and legal aspects.

    PubMed

    Bhalla, C K

    1978-06-01

    The problem of abandoned children is of great magnitude in India. Placement of these children in a family environment is essential for their physical, mental, and emotional development. Adoption must be approached from the child welfare perspective. The pediatrician can play an important role in the adoption process. The pediatrician should perform a thorough medical examination of infants to be adopted, both to ensure the child's welfare and to give adoptive parents an assessment of the child's health. Information should be collected on the medical history of the child's biologic parents to aid in the evaluation process. Adoptive parents should also undergo medical and pyschological examinations. Pediatricians can additionally work with social welfare departments in establishing criteria for matching children with adoptive parents. Adoptions in India are currently governed by provisions or the 1956 Hindu Adoptions and Maintenance Act. Since this legislation excludes groups such as Muslims, Christians, and Parsis from its purview, there has been a demand for national legislation providing a uniform adoption law for all the communities in India. The Union Government introduced such a comprehensive bill in 1972, the Adoption of Children Bill; however, no action was ever taken. It is urged that this legislation be reactivated, and that the restriction on the removal of children for adoption outside India be lifted. PMID:721273

  17. Factors affecting adoption, implementation fidelity, and sustainability of the Redesigned Community Health Fund in Tanzania: a mixed methods protocol for process evaluation in the Dodoma region

    PubMed Central

    Kalolo, Albino; Radermacher, Ralf; Stoermer, Manfred; Meshack, Menoris; De Allegri, Manuela

    2015-01-01

    Background Despite the implementation of various initiatives to address low enrollment in voluntary micro health insurance (MHI) schemes in sub-Saharan Africa, the problem of low enrollment remains unresolved. The lack of process evaluations of such interventions makes it difficult to ascertain whether their poor results are because of design failures or implementation weaknesses. Objective In this paper, we describe a process evaluation protocol aimed at opening the ‘black box’ to evaluate the implementation processes of the Redesigned Community Health Fund (CHF) program in the Dodoma region of Tanzania. Design The study employs a cross-sectional mixed methods design and is being carried out 3 years after the launch of the Redesigned CHF program. The study is grounded in a conceptual framework which rests on the Diffusion of Innovation Theory and the Implementation Fidelity Framework. The study utilizes a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews, and document review), and aligns the evaluation to the Theory of Intervention developed by our team. Quantitative data will be used to measure program adoption, implementation fidelity, and their moderating factors. Qualitative data will be used to explore the responses of stakeholders to the intervention, contextual factors, and moderators of adoption, implementation fidelity, and sustainability. Discussion This protocol describes a systematic process evaluation in relation to the implementation of a reformed MHI. We trust that the theoretical approaches and methodologies described in our protocol may be useful to inform the design of future process evaluations focused on the assessment of complex interventions, such as MHI schemes. PMID:26679408

  18. Strengthening Adoption Practice, Listening to Adoptive Families

    ERIC Educational Resources Information Center

    Atkinson, Anne; Gonet, Patricia

    2007-01-01

    In-depth interviews with 500 adoptive families who received postadoption services through Virginia's Adoptive Family Preservation (AFP) program paint a richly detailed picture of the challenges adoptive families face and what they need to sustain adoption for many years after finalization. Findings document the need for support in a variety of…

  19. Relational Machine Learning for Electronic Health Record-Driven Phenotyping

    PubMed Central

    Peissig, Peggy L.; Costa, Vitor Santos; Caldwell, Michael D.; Rottscheit, Carla; Berg, Richard L.; Mendonca, Eneida A.; Page, David

    2014-01-01

    Objective Electronic health records (EHR) offer medical and pharmacogenomics research unprecedented opportunities to identify and classify patients at risk. EHRs are collections of highly inter-dependent records that include biological, anatomical, physiological, and behavioral observations. They comprise a patient’s clinical phenome, where each patient has thousands of date-stamped records distributed across many relational tables. Development of EHR computer-based phenotyping algorithms require time and medical insight from clinical experts, who most often can only review a small patient subset representative of the total EHR records, to identify phenotype features. In this research we evaluate whether relational machine learning (ML) using Inductive Logic Programming (ILP) can contribute to addressing these issues as a viable approach for EHR-based phenotyping. Methods Two relational learning ILP approaches and three well-known WEKA (Waikato Environment for Knowledge Analysis) implementations of non-relational approaches (PART, J48, and JRIP) were used to develop models for nine phenotypes. International Classification of Diseases, Ninth Revision (ICD-9) coded EHR data were used to select training cohorts for the development of each phenotypic model. Accuracy, precision, recall, F-Measure, and Area Under the Receiver Operating Characteristic (AUROC) curve statistics were measured for each phenotypic model based on independent manually verified test cohorts. A two-sided binomial distribution test (sign test) compared the five ML approaches across phenotypes for statistical significance. Results We developed an approach to automatically label training examples using ICD-9 diagnosis codes for the ML approaches being evaluated. Nine phenotypic models for each MLapproach were evaluated, resulting in better overall model performance in AUROC using ILP when compared to PART (p=0.039), J48 (p=0.003) and JRIP (p=0.003). Discussion ILP has the potential to improve

  20. Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis

    PubMed Central

    Ventres, William; Kooienga, Sarah; Vuckovic, Nancy; Marlin, Ryan; Nygren, Peggy; Stewart, Valerie

    2006-01-01

    PURPOSE Little is known about the effects of the electronic health record (EHR) on physician-patient encounters. The objectives of this study were to identify the factors that influence the manner by which physicians use the EHR with patients. METHODS This ethnographic study included 4 qualitative components: 80 hours of participant observation in 4 primary care offices in the Pacific Northwest; individual interviews with 52 patients, 12 office staff members, 23 physicians, and 1 nurse-practitioner; videotaped reviews of 29 clinical encounters; and 5 focus-group interviews with physicians and computer advocates. The main outcome measures were factors that influence how physicians use the EHR. Researchers qualitatively derived these factors through serial reviews of data. RESULTS This study identified 14 factors that influence how EHRs are used and perceived in medical practice today. These factors were categorized into 4 thematic domains: (1) spatial—effect of the physical presence and location of EHRs on interactions between physicians and patients; (2) relational—perceptions of physicians and patients about the EHR and how those perceptions affected its use; (3) educational—issues of developing physicians’ proficiency with and improving patients’ understandings about EHR use; and (4) structural—institutional and technological forces that influence how physicians perceived their use of EHR. CONCLUSIONS This study found that the introduction of EHRs into practice influences multiple cognitive and social dimensions of the clinical encounter. It brings into focus important questions that through further inquiry can determine how to make best use of the EHR to enhance therapeutic relationships. PMID:16569715

  1. Factors in medical student beliefs about electronic health record use.

    PubMed

    Harle, Christopher A; Gruber, Laura A; Dewar, Marvin A

    2014-01-01

    Healthcare providers' ongoing investment in electronic health records (EHRs) necessitates an understanding of physicians' expectations about using EHRs. Such understanding may aid educators and administrators when utilizing scarce resources during EHR training and implementation activities. This study aimed to link individual medical student characteristics to their perceptions of EHRs' ease of use and usefulness. This study employed a cross-sectional survey of 126 third-year medical students at a large southeastern university. Using a questionnaire designed for this study and containing previously validated items, the study team measured and related students' expectations about EHR ease of use and usefulness to their computer self-efficacy, openness to change, personality traits, and demographic characteristics. On a seven-point scale, men reported, on average, ease-of-use scores that were 0.71 higher than women's (p < .001). Also, increased computer self-efficacy related to higher expectations of EHR ease of use (p < .01) and usefulness (p < .05). Openness-to-change scores were also associated with higher expectations of EHR ease of use (p < .01) and usefulness (p < .001). Finally, a more conscientious personality was positively associated with EHR ease of use (p < .01). Our findings suggest that medical educators and administrators may consider targeting EHR management strategies on the basis of individual differences. Enhanced training and support interventions may be helpful to women or to clinicians with lower computer self-efficacy, lower openness to change, or less conscientious personalities. Also, current and future physicians who rate higher in terms of self-efficacy, openness to change, or conscientiousness may be useful as champions of EHR use among their peers.

  2. Adolescent Use of Electronic Cigarettes: An Emergent Health Concern for Pediatric Nurses.

    PubMed

    Johnson, Molly; Pennington, Nicole

    2015-01-01

    Recent statistics show an increasing trend of electronic cigarette usage among adolescents. Despite common misconceptions, electronic cigarette use does not reduce cigarette use among adolescents and can potentially increase cigarette dependence via nicotine addiction and modeling of smoking behaviors. Pediatric nurses and health care providers should be aware of the popularity and safety concerns of electronic cigarettes so that they can properly provide education regarding the possible negative health effects of adolescent electronic cigarette use, raise awareness of this public health concern, and impact policies in their communities.

  3. Ethical, legal, and social implications of incorporating genomic information into electronic health records

    PubMed Central

    Hazin, Ribhi; Brothers, Kyle B.; Malin, Bradley A.; Koenig, Barbara A.; Sanderson, Saskia C.; Rothstein, Mark A.; Williams, Marc S.; Clayton, Ellen W.; Kullo, Iftikhar J.

    2014-01-01

    The inclusion of genomic data in the electronic health record raises important ethical, legal, and social issues. In this article, we highlight these challenges and discuss potential solutions. We provide a brief background on the current state of electronic health records in the context of genomic medicine, discuss the importance of equitable access to genome-enabled electronic health records, and consider the potential use of electronic health records for improving genomic literacy in patients and providers. We highlight the importance of privacy, access, and security, and of determining which genomic information is included in the electronic health record. Finally, we discuss the challenges of reporting incidental findings, storing and reinterpreting genomic data, and nondocumentation and duty to warn family members at potential genetic risk. PMID:24030434

  4. Ethical, legal, and social implications of incorporating genomic information into electronic health records.

    PubMed

    Hazin, Ribhi; Brothers, Kyle B; Malin, Bradley A; Koenig, Barbara A; Sanderson, Saskia C; Rothstein, Mark A; Williams, Marc S; Clayton, Ellen W; Kullo, Iftikhar J

    2013-10-01

    The inclusion of genomic data in the electronic health record raises important ethical, legal, and social issues. In this article, we highlight these challenges and discuss potential solutions. We provide a brief background on the current state of electronic health records in the context of genomic medicine, discuss the importance of equitable access to genome-enabled electronic health records, and consider the potential use of electronic health records for improving genomic literacy in patients and providers. We highlight the importance of privacy, access, and security, and of determining which genomic information is included in the electronic health record. Finally, we discuss the challenges of reporting incidental findings, storing and reinterpreting genomic data, and nondocumentation and duty to warn family members at potential genetic risk.

  5. [Risk communication during health crises: results of a cross-sectional study to evaluate the effectiveness of adopted corporate communication strategies during the H1N1 influenza pandemic in Italy and on the training needs of health professionals].

    PubMed

    De Giusti, Maria; Mannocci, Alice; Miccoli, Silvia; Palazzo, Caterina; Di Thiene, Domitilla; Scalmato, Valeria; Ursillo, Paolo; Monteduro, Maria Antonietta; Turri, Alberto; Mazzoli, Pier Giovanni; Boccia, Antonio; La Torre, Giuseppe

    2012-01-01

    The objectives of this study were to evaluate the effectiveness of corporate communication activities carried out during the A(H1N1) pandemic influenza in Italy and to identify educational needs of health professionals with regards to crisis communication. The study compared two samples representing respectively the general population and health professionals, living in different regions of northern, central and southern Italy. A self-administered questionnaire was used, with questions on knowledge about preventive measures during a pandemic and on satisfaction with the adopted communication campaigns. Study results highlight that both samples had very little knowledge of appropriate preventive behaviors to be adopted during a pandemic. The sample of health professionals received a greater amount of information about the pandemic with respect to the general population and showed a strong interest toward the problem of receiving adequate training in risk communication. The degree of knowledge about preventive measures is directly proportional to the existence of institutional communication activities and to having consulted a health professional.

  6. Electronic health records: Is it a risk worth taking in healthcare delivery?

    PubMed Central

    Raposo, Vera Lúcia

    2015-01-01

    The electronic health record represents a major change in healthcare delivery, either for health professionals and health institutions, either for patients. In this essay we will mainly focus on its consequences regarding patient safety and medical liability. In this particular domain the electronic health record has dual effects: on one side prevents medical errors and, in this sense, promotes patient safety and protects the doctor from lawsuits; but, on the other side, when not used properly, it may also generate other kind of errors, potentially threatening patient safety and, therefore, increasing the risk of juridical liability for the physician. This paper intends to underline the main human errors, technologic mistakes and medical faults that may occur while using the electronic health record and the ways to overcome them, also explaining how the electronic health record may be used in court during a judicial proceeding. PMID:26693253

  7. Using Multifactorial Experiments for Comparative Effectiveness Research in Physician Practices with Electronic Health Record

    PubMed Central

    Zurovac, Jelena; Moreno, Lorenzo; Crosson, Jesse; Brown, Randall; Schmitz, Robert

    2013-01-01

    Two key challenges related to conducting comparative effectiveness research are the lack of available data and the lack of rigorous techniques for efficiently and quickly testing the effectiveness of the many possible ways of implementing components of care. The confluence of two things offers the promise of overcoming these challenges: (1) the increased adoption of electronic health records (EHRs), which can provide easier access to clinical information, and (2) burgeoning appreciation for an under-used but powerful statistical research and evaluation method for multifactor interventions known as multifactor experimental design. The use of multifactorial experiments paired with EHR data has great potential to help providers conduct rapid-cycle comparative effectiveness research and examine alternative ways of implementing care. Its power is its ability to enable scientifically rigorous testing of many facets of care provision simultaneously in real-world settings where change is ongoing. In this paper, we identify the opportunities for using efficient multifactorial designs and EHR data to evaluate quality-improvement efforts in physician practices. We illustrate the power of multifactorial designs through several examples relevant to physician practices with EHRs, such as evaluating clinical decision support features and studying components of a patient-centered medical home. PMID:25848579

  8. Importance of health information technology, electronic health records, and continuously aggregating data to comparative effectiveness research and learning health care.

    PubMed

    Miriovsky, Benjamin J; Shulman, Lawrence N; Abernethy, Amy P

    2012-12-01

    Rapidly accumulating clinical information can support cancer care and discovery. Future success depends on information management, access, use, and reuse. Electronic health records (EHRs) are highlighted as a critical component of evidence development and implementation, but to fully harness the potential of EHRs, they need to be more than electronic renderings of the traditional paper medical chart. Clinical informatics and structured accessible secure data captured through EHR systems provide mechanisms through which EHRs can facilitate comparative effectiveness research (CER). Use of large linked administrative databases to answer comparative questions is an early version of informatics-enabled CER familiar to oncologists. An updated version of informatics-enabled CER relies on EHR-derived structured data linked with supplemental information to provide patient-level information that can be aggregated and analyzed to support hypothesis generation, comparative assessment, and personalized care. As implementation of EHRs continues to expand, electronic databases containing information collected via EHRs will continuously aggregate; aggregating data enhanced with real-time analytics can provide point-of-care evidence to oncologists, tailored to patient-level characteristics. The system learns when clinical care informs research, and insights derived from research are reinvested in care. Challenges must be overcome, including interoperability, standardization, access, and development of real-time analytics.

  9. Misclassification in assessment of diabetogenic risk using electronic health records†

    PubMed Central

    Winterstein, Almut G.; Kubilis, Paul; Bird, Steve; Cooper-DeHoff, Rhonda M.; Nichols, Greg A.; Delaney, Joseph A.

    2016-01-01

    Purpose Suspected diabetogenic effects or drug indication may increase testing for diabetes mellitus (DM), resulting in measurement bias when evaluating diabetogenic drug effects. We sought to evaluate the validity of electronic health record data in determining DM risk. Methods We used time-dependent Cox proportional hazard models within a retrospective cohort design to assess associations between use of antihypertensives, statins, atypical antipsychotics, and antidepressants, and two endpoints: (i) DM onset defined as fasting blood glucose (BG) ≥126 mg/dl, random BG ≥200 mg/dl, HbA1c ≥7.0%, or antidiabetic drug initiation; and (ii) first negative DM test. We used Poisson regression to assess the influence of these drugs on DM testing rates. Patients aged 35–64 years enrolled in Kaiser Permanente Northwest between 1997 and 2010 entered the cohort at the first negative BG test after ≥6 months without manifest DM. Results All drug classes showed significant associations not only with DM onset but also with first negative BG test and with DM testing rates. Antipsychotics had the greatest diabetogenic risk (adjusted hazard ratio [HR] = 1.73 [1.44–2.08]), the greatest propensity for a first negative test (adjusted HR = 1.87 [1.74–2.01]), and the highest testing rate (adjusted rate ratio = 1.76 [1.72–1.81]. Although renin–angiotensin system blockers and calcium channel blockers have shown no diabetogenic risk in clinical trials, both were associated with DM (HR = 1.19 [1.12–1.26] and 1.27 [1.17–1.38]), a negative glucose test (1.38 [1.35–1.41] and 1.24 [1.20–1.28]), and increased testing rates (rate ratio = 1.26 [1.24–1.27] and 1.27 [1.25–1.28]). Conclusion Caution should be used when diabetogenic risk is evaluated using data that rely on DM testing in general practice. PMID:24923707

  10. Integrating Genomic Resources with Electronic Health Records using the HL7 Infobutton Standard

    PubMed Central

    Overby, Casey Lynnette; Del Fiol, Guilherme; Rubinstein, Wendy S.; Maglott, Donna R.; Nelson, Tristan H.; Milosavljevic, Aleksandar; Martin, Christa L.; Goehringer, Scott R.; Freimuth, Robert R.; Williams, Marc S.

    2016-01-01

    Summary Background The Clinical Genome Resource (ClinGen) Electronic Health Record (EHR) Workgroup aims to integrate ClinGen resources with EHRs. A promising option to enable this integration is through the Health Level Seven (HL7) Infobutton Standard. EHR systems that are certified according to the US Meaningful Use program provide HL7-compliant infobutton capabilities, which can be leveraged to support clinical decision-making in genomics. Objectives To integrate genomic knowledge resources using the HL7 infobutton standard. Two tactics to achieve this objective were: (1) creating an HL7-compliant search interface for ClinGen, and (2) proposing guidance for genomic resources on achieving HL7 Infobutton standard accessibility and compliance. Methods We built a search interface utilizing OpenInfobutton, an open source reference implementation of the HL7 Infobutton standard. ClinGen resources were assessed for readiness towards HL7 compliance. Finally, based upon our experiences we provide recommendations for publishers seeking to achieve HL7 compliance. Results Eight genomic resources and two sub-resources were integrated with the ClinGen search engine via OpenInfobutton and the HL7 infobutton standard. Resources we assessed have varying levels of readiness towards HL7-compliance. Furthermore, we found that adoption of standard terminologies used by EHR systems is the main gap to achieve compliance. Conclusion Genomic resources can be integrated with EHR systems via the HL7 Infobutton standard using OpenInfobutton. Full compliance of genomic resources with the Infobutton standard would further enhance interoperability with EHR systems. PMID:27579472

  11. Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?

    PubMed Central

    Marino, Miguel; Hoopes, Megan; Bailey, Steffani R; Gold, Rachel; O’Malley, Jean; Angier, Heather; Nelson, Christine; Cottrell, Erika; Devoe, Jennifer

    2015-01-01

    Objective To validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. Materials and Methods Subjects Children visiting any of 96 CHCs (N = 69 189) from 2011 to 2012. Analysis The authors measured correspondence (whether or not the visit was covered by Medicaid) between EHR coverage data and (i) reimbursement data and (ii) coverage data from Medicaid. Results Compared to reimbursement data and Medicaid coverage data, EHR coverage data had high agreement (87% and 95%, respectively), sensitivity (0.97 and 0.96), positive predictive value (0.88 and 0.98), but lower kappa statistics (0.32 and 0.49), specificity (0.27 and 0.60), and negative predictive value (0.66 and 0.45). These varied among clinics. Discussion/Conclusions EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients. Future work should attempt to replicate these analyses in other settings. PMID:25888586

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

    NASA Astrophysics Data System (ADS)

    Davies, George

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

  13. Correlation of Electronic Health Records Use and Reduced Prevalence of Diabetes Co-Morbidities

    ERIC Educational Resources Information Center

    Eller, James D.

    2013-01-01

    The general problem is Native American tribes have high prevalence rates of diabetes. The specific problem is the failure of IHS sites to adopt EHR may cause health care providers to miss critical opportunities to improve screening and triage processes that result in quality improvement. The purpose of the quantitative correlational study was to…

  14. 45 CFR 170.210 - Standards for health information technology to protect electronic health information created...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Standards for health information technology to... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH INFORMATION TECHNOLOGY HEALTH INFORMATION... FOR HEALTH INFORMATION TECHNOLOGY Standards and Implementation Specifications for Health...

  15. 45 CFR 170.210 - Standards for health information technology to protect electronic health information created...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Standards for health information technology to... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH INFORMATION TECHNOLOGY HEALTH INFORMATION... FOR HEALTH INFORMATION TECHNOLOGY Standards and Implementation Specifications for Health...

  16. Policy brief on the current status of certification of electronic Health Records in the US and Europe.

    PubMed

    De Moor, Georges; O'Brien, John; Fridsma, Doug; Bean, Carol; Devlies, Jos; Cusack, Caitlin M; Bloomrosen, Meryl; Lorenzi, Nancy; Coorevits, Pascal

    2011-01-01

    If Electronic Health Record systems are to provide an effective contribution to healthcare, a set of benchmarks need to be set to ensure quality control and interoperability of systems. This paper outlines the prevailing status of EHR certification in the US and the EU, compares and contrasts established schemes and poses opportunities for convergence of activity in the domain designed to advance certification endeavours generally. Several EU Member States have in the past proceeded with EHR systems quality labeling and/or certification, but these differ in scope, in legal framework under which they operate, in policies (legislation and financial incentives), in organization, and perhaps most importantly in the quality criteria used for benchmarking. Harmonization, therefore, became a must. Now, through EuroRec (with approaches ranging from self-assessment to third party certification depending on the level of confidence needed) and its Seals, the possibility to achieve this for EHR systems has started in the whole of Europe. The US HITECH Act also attempts to create incentives for all hospitals and eligible providers to adopt and use electronic information. A centerpiece of the Act is to put in place strong financial incentives to adopt and meaningfully use EHRs. The HHS/EHR Certification Programme makes use of ISO/IEC 170XX standards for accreditation, testing and certification. The approved test method addresses the functional and the interoperability requirements defined in the Final Rule criteria and standards. To date six Authorized Testing and Certification Bodies (ATCBs) are testing and certifying products in the US.

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

    PubMed

    Ben-Assuli, Ofir; Leshno, Moshe

    2016-09-01

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

  18. ELECTRONIC HEALTH IN GHANA: CURRENT STATUS AND FUTURE PROSPECTS

    PubMed Central

    Afarikumah, Ebenezer

    2014-01-01

    The health-care system in Ghana is similar to those in other developing countries and access to health services for remote communities is extremely limited. In July, 2010, the Government of Ghana launched the national e health strategy. A number of international organizations have initiated various pilot projects, including disseminating and collecting data, education initiatives and telemedicine. In addition, several institutions and organizations are dedicated to the promotion of e-health and a range of Web-based health consultancy services have begun. The main objective of this study is to provide an overview of eHealth activities in Ghana. It was a daunting task, not least because of the need to gather information on eHealth projects and initiatives in Ghana, as there is no existing repository of such information. Through literature search in Africa journals online, Hinari, Medline, Google.com, Journal of Telemedicine and e-Health, Journal of Telemedicine and Telecare, Journal of Medical Internet Research and Interaction with eHealth experts, followed up with some of the authors' for directions to other projects, and following the references in some articles. A total of twenty-two (22) pilot projects have been identified in Ghana. Mobile devices in use range from PDAs to simple phones and smart phones. The key findings of this research are that there are about 22 eHealth project at various stages of implementation in Ghana. Some of these projects have wind up and others are still being implemented. Mobile devices in use range from PDAs to simple mobile phones and smart phones. Most of the projects have been donor initiated. Data collection started in March 2010 to June 2013. Although eHealth seems to have a limited role in Ghana at present, there is growing interest in the opportunities it may offer in terms of improving the delivery and access to services, especially in remote locations. Recommendations for further research are provided. PMID:24678382

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

    PubMed Central

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

    2015-01-01

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

  20. A physician's role following a breach of electronic health information.

    PubMed

    Kim, Daniel; Schleiter, Kristin; Crigger, Bette-Jane; McMahon, John W; Benjamin, Regina M; Douglas, Sharon P

    2010-01-01

    The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians' professional ethical responsibility in the event that the security of patients' electronic records is breached.