The electronic medical record in dermatology.

PubMed

Grosshandler, Joshua A; Tulbert, Brittain; Kaufmann, Mark D; Bhatia, Ashish; Brodell, Robert T

2010-09-01

Governmental incentives to stimulate the "meaningful use" of electronic medical records and future disincentives for Medicaid and Medicare provide an impetus for dermatologists to consider adding this technology to their clinical practice. Dermatologists should carefully weigh the pros and cons of establishing an electronic medical record system before incorporating this expensive technology. This article reviews available scientific and economic data required for dermatologists to help make an informed choice.

EMERSE: The Electronic Medical Record Search Engine

PubMed Central

Hanauer, David A.

2006-01-01

EMERSE (The Electronic Medical Record Search Engine) is an intuitive, powerful search engine for free-text documents in the electronic medical record. It offers multiple options for creating complex search queries yet has an interface that is easy enough to be used by those with minimal computer experience. EMERSE is ideal for retrospective chart reviews and data abstraction and may have potential for clinical care as well.

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

PubMed

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

2016-03-05

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

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

PubMed

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

2012-06-01

Patient records, including doctors' diagnoses of diseases, trace of treatments and patients' conditions, nursing actions, and examination results from allied health profession departments, are the most important medical records of patients in medical systems. With patient records, medical staff can instantly understand the entire medical information of a patient so that, according to the patient's conditions, more accurate diagnoses and more appropriate in-depth treatments can be provided. Nevertheless, in such a modern society with booming information technologies, traditional paper-based patient records have faced a lot of problems, such as lack of uniform formats, low data mobility, slow data transfer, illegible handwritings, enormous and insufficient storage space, difficulty of conservation, being easily damaged, and low transferability. To improve such drawbacks, reduce medical costs, and advance medical quality, paper-based patient records are modified into electronic medical records and reformed into electronic patient records. However, since electronic patient records used in various hospitals are diverse and different, in consideration of cost, it is rather difficult to establish a compatible and complete integrated electronic patient records system to unify patient records from heterogeneous systems in hospitals. Moreover, as the booming of the Internet, it is no longer necessary to build an integrated system. Instead, doctors can instantly look up patients' complete information through the Internet access to electronic patient records as well as avoid the above difficulties. Nonetheless, the major problem of accessing to electronic patient records cross-hospital systems exists in the security of transmitting and accessing to the records in case of unauthorized medical personnels intercepting or stealing the information. This study applies the Mobile Agent scheme to cope with the problem. Since a Mobile Agent is a program, which can move among hosts and automatically disperse arithmetic processes, and moves from one host to another in heterogeneous network systems with the characteristics of autonomy and mobility, decreasing network traffic, reducing transfer lag, encapsulating protocol, availability on heterogeneous platforms, fault-tolerance, high flexibility, and personalization. However, since a Mobile Agent contacts and exchanges information with other hosts or agents on the Internet for rapid exchange and access to medical information, the security is threatened. In order to solve the problem, this study proposes a key management scheme based on Lagrange interpolation formulas and hierarchical management structure to make Mobile Agents a more secure and efficient access control scheme for electronic patient record systems when applied to the access of patients' personal electronic patient records cross hospitals. Meanwhile, with the comparison of security and efficacy analyses being the feasibility of validation scheme and the basis of better efficiency, the security of Mobile Agents in the process of operation can be guaranteed, key management efficacy can be advanced, and the security of the Mobile Agent system can be protected.

Customization of electronic medical record templates to improve end-user satisfaction.

PubMed

Gardner, Carrie Lee; Pearce, Patricia F

2013-03-01

Since 2004, increasing importance has been placed on the adoption of electronic medical records by healthcare providers for documentation of patient care. Recent federal regulations have shifted the focus from adoption alone to meaningful use of an electronic medical record system. As proposed by the Technology Acceptance Model, the behavioral intention to use technology is determined by the person's attitude toward usage. The purpose of this quality improvement project was to devise and implement customized templates into an existent electronic medical record system in a single clinic and measure the satisfaction of the clinic providers with the system before and after implementation. Provider satisfaction with the electronic medical record system was evaluated prior to and following template implementation using the current version 7.0 of the Questionnaire for User Interaction Satisfaction tool. Provider comments and improvement in the Questionnaire for User Interaction Satisfaction levels of rankings following template implementation indicated a positive perspective by the providers in regard to the templates and customization of the system.

EMERSE: The Electronic Medical Record Search Engine

PubMed Central

Hanauer, David A.

2006-01-01

EMERSE (The Electronic Medical Record Search Engine) is an intuitive, powerful search engine for free-text documents in the electronic medical record. It offers multiple options for creating complex search queries yet has an interface that is easy enough to be used by those with minimal computer experience. EMERSE is ideal for retrospective chart reviews and data abstraction and may have potential for clinical care as well. PMID:17238560

Electronic medical records for otolaryngology office-based practice.

PubMed

Chernobilsky, Boris; Boruk, Marina

2008-02-01

Pressure is mounting on physicians to adopt electronic medical records. The field of health information technology is evolving rapidly with innovations and policies often outpacing science. We sought to review research and discussions about electronic medical records from the past year to keep abreast of these changes. Original scientific research, especially from otolaryngologists, is lacking in this field. Adoption rates are slowly increasing, but more of the burden is shouldered by physicians despite policy efforts and the clear benefits to third-party payers. Scientific research from the past year suggests lack of improvements and even decreasing quality of healthcare with electronic medical record adoption in the ambulatory care setting. The increasing prevalence and standardization of electronic medical record systems results in a new set of problems including rising costs, audits, difficulties in transition and public concerns about security of information. As major players in healthcare continue to push for adoption, increased effort must be made to demonstrate actual improvements in patient care in the ambulatory care setting. More scientific studies are needed to demonstrate what features of electronic medical records actually improve patient care. Otolaryngologists should help each other by disseminating research about improvement in patient outcomes with their systems since current adoption and outcomes policies do not apply to specialists.

[From planning to realization of an electronic patient record].

PubMed

Krämer, T; Rapp, R; Krämer, K L

1999-03-01

The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the necessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occurred during this process.

From planning to realisation of an electronic patient record.

PubMed

Krämer, T; Rapp, R; Krämer, K-L

1999-03-01

The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the neccessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occured during this process.

Electronic medical archives: a different approach to applying re-signing mechanisms to digital signatures.

PubMed

Chen, Tzer-Long; Lin, Frank Y S

2011-08-01

Electronic medical records can be defined as a digital format of the traditionally paper-based anamneses, which contains the history of a patient such as his somewhat illness, current health problems, and his chronic treatments. An electronic anamnesis is meant to make the patient's health information more conveniently accessible and transferable between different medical institutions and also easier to be kept quite a long time. Because of such transferability and accessibility of electronic anamneses, we can use less resource than before on storing the patients' medical information. This also means that medical care providers could save more funds on record-keeping and access a patient's medical background directly since shown on the computer screen more quickly and easily. Overall, the service quality has seemingly improved greatly. However, the usage of electronic anamneses involves in some concerned issues such as its related law declaration, and the security of the patient's confidential information. Because of these concerns, a secure medical networking scheme is taking into consideration. Nowadays, the administrators at the medical institutions are facing more challenges on monitoring computers and network systems, because of dramatic advances in this field. For instance, a trusted third party is authorized to access some medical records for a certain period of time. In regard to the security purpose, all the electronic medical records are embedded with both of the public-key infrastructure (PKI) cryptography and the digital signature technique so as to ensure the records well-protected. Since the signatures will be invalid due to the revocation or time expiration, the security of records under this premise would turn into vulnerable. Hence, we propose a re-signing scheme, whose purpose is to make a going-expired digital signature been resigned in time, in keeping with the premise of not conflicting with the laws, morals, and privacy while maintaining the security of the electronic medical records.

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

PubMed

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

2009-12-20

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

Electronic Medical Business Operations System

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

Cannon, D. T.; Metcalf, J. R.; North, M. P.

Electronic Management of medical records has taken a back seat both in private industry and in the government. Record volumes continue to rise every day and management of these paper records is inefficient and very expensive. In 2005, the White House announced support for the development of electronic medical records across the federal government. In 2006, the DOE issued 10 CFR 851 requiring all medical records be electronically available by 2015. The Y-12 National Security Complex is currently investing funds to develop a comprehensive EMR to incorporate the requirements of an occupational health facility which are common across the Nuclearmore » Weapons Complex (NWC). Scheduling, workflow, and data capture from medical surveillance, certification, and qualification examinations are core pieces of the system. The Electronic Medical Business Operations System (EMBOS) will provide a comprehensive health tool solution to 10 CFR 851 for Y-12 and can be leveraged to the Nuclear Weapon Complex (NWC); all site in the NWC must meet the requirements of 10 CFR 851 which states that all medical records must be electronically available by 2015. There is also potential to leverage EMBOS to the private4 sector. EMBOS is being developed and deployed in phases. When fully deployed the EMBOS will be a state-of-the-art web-enabled integrated electronic solution providing a complete electronic medical record (EMR). EMBOS has been deployed and provides a dynamic electronic medical history and surveillance program (e.g., Asbestos, Hearing Conservation, and Respirator Wearer) questionnaire. Table 1 below lists EMBOS capabilities and data to be tracked. Data to be tracked: Patient Demographics – Current/Historical; Physical Examination Data; Employee Medical Health History; Medical Surveillance Programs; Patient and Provider Schedules; Medical Qualification/Certifications; Laboratory Data; Standardized Abnormal Lab Notifications; Prescription Medication Tracking and Dispensing; Allergies; Non-Occupational Illness and Injury Visits; Occupational Recommendations/Restrictions; Diagnosis/Vital Signs/Blood Pressures; Immunizations; Return to Work Visits Capabilities: Targeted Health Assessments; Patient Input Capabilities for Questionnaires; Medical Health History; Surveillance Programs; Human Reliability Program; Scheduling; Automated Patient Check-in/Check-out; Provider & Patient Workflow; Laboratory Interface & Device Integration; Human Reliability Program Processing; Interoperability with SAP, IH, IS, RADCON; Coding: ICED-9/10; Desktop Integration; Interface/Storage of Digital X-Rays (PACS)« less

Cognitive analyses of a paper medical record and electronic medical record on the documentation of two nursing tasks: patient education and adherence assessment of insulin administration.

PubMed Central

Rinkus, Susan M.; Chitwood, Ainsley

2002-01-01

The incorporation of electronic medical records into busy physician clinics has been a major development in the healthcare industry over the past decade. Documentation of key nursing activities, especially when interacting with patients who have chronic diseases, is often lacking or missing from the paper medical record. A case study of a patient with diabetes mellitus was created. Well established methods for the assessment of usability in the areas of human-computer interaction and computer supported cooperative work were employed to compare the nursing documentation of two tasks in a commercially available electronic medical record (eRecord) and in a paper medical record. Overall, the eRecord was found to improve the timeliness and quality of nursing documentation. With certain tasks, the number of steps to accomplish the same task was higher, which may result in the perception by the end user that the tool is more complex and therefore difficult to use. Recommendations for the eRecord were made to expand the documentation of patient teaching and adherence assessment and to incorporate web technology for patient access to medical records and healthcare information. PMID:12463905

From papyrus to the electronic tablet: a brief history of the clinical medical record with lessons for the digital age.

PubMed

Gillum, Richard F

2013-10-01

A major transition is underway in documentation of patient-related data in clinical settings with rapidly accelerating adoption of the electronic health record and electronic medical record. This article examines the history of the development of medical records in the West in order to suggest lessons applicable to the current transition. The first documented major transition in the evolution of the clinical medical record occurred in antiquity, with the development of written case history reports for didactic purposes. Benefiting from Classical and Hellenistic models earlier than physicians in the West, medieval Islamic physicians continued the development of case histories for didactic use. A forerunner of modern medical records first appeared in Paris and Berlin by the early 19th century. Development of the clinical record in America was pioneered in the 19th century in major teaching hospitals. However, a clinical medical record useful for direct patient care in hospital and ambulatory settings was not developed until the 20th century. Several lessons are drawn from the 4000-year history of the medical record that may help physicians improve patient care in the digital age. Copyright © 2013 Elsevier Inc. All rights reserved.

Urban Alabama Physicians and the Electronic Medical Record: A Qualitative Study

ERIC Educational Resources Information Center

Tiggle, Michele

2012-01-01

The electronic medical record (EMR) is an information technology tool supporting the examination, treatment, and care of a patient. The EMR allows physicians to view a patient's record showing current medications, a history of visits from health care providers with notes from those visits, a problem list, a functional status assessment, a schedule…

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…

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

PubMed

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

2010-10-01

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

The Importance of the Medical Record: A Critical Professional Responsibility.

PubMed

Ngo, Elizabeth; Patel, Nachiket; Chandrasekaran, Krishnaswamy; Tajik, A Jamil; Paterick, Timothy E

2016-01-01

Comprehensive, detailed documentation in the medical record is critical to patient care and to a physician when allegations of negligence arise. Physicians, therefore, would be prudent to have a clear understanding of this documentation. It is important to understand who is responsible for documentation, what is important to document, when to document, and how to document. Additionally, it should be understood who owns the medical record, the significance of the transition to the electronic medical record, problems and pitfalls when using the electronic medical record, and how the Health Information Technology for Economic and Clinical Health Act affects healthcare providers and health information technology.

The Medical Home

MedlinePlus

... in files on a computer or within an electronic medical record (EMR) , or in paper folders. When ... 2014 More on this topic for: Parents Teens Electronic Health Records Talking to Your Child's Doctor How ...

Identifying individuals with physician-diagnosed chronic obstructive pulmonary disease in primary care electronic medical records: a retrospective chart abstraction study.

PubMed

Lee, Theresa M; Tu, Karen; Wing, Laura L; Gershon, Andrea S

2017-05-15

Little is known about using electronic medical records to identify patients with chronic obstructive pulmonary disease to improve quality of care. Our objective was to develop electronic medical record algorithms that can accurately identify patients with obstructive pulmonary disease. A retrospective chart abstraction study was conducted on data from the Electronic Medical Record Administrative data Linked Database (EMRALD ® ) housed at the Institute for Clinical Evaluative Sciences. Abstracted charts provided the reference standard based on available physician-diagnoses, chronic obstructive pulmonary disease-specific medications, smoking history and pulmonary function testing. Chronic obstructive pulmonary disease electronic medical record algorithms using combinations of terminology in the cumulative patient profile (CPP; problem list/past medical history), physician billing codes (chronic bronchitis/emphysema/other chronic obstructive pulmonary disease), and prescriptions, were tested against the reference standard. Sensitivity, specificity, and positive/negative predictive values (PPV/NPV) were calculated. There were 364 patients with chronic obstructive pulmonary disease identified in a 5889 randomly sampled cohort aged ≥ 35 years (prevalence = 6.2%). The electronic medical record algorithm consisting of ≥ 3 physician billing codes for chronic obstructive pulmonary disease per year; documentation in the CPP; tiotropium prescription; or ipratropium (or its formulations) prescription and a chronic obstructive pulmonary disease billing code had sensitivity of 76.9% (95% CI:72.2-81.2), specificity of 99.7% (99.5-99.8), PPV of 93.6% (90.3-96.1), and NPV of 98.5% (98.1-98.8). Electronic medical record algorithms can accurately identify patients with chronic obstructive pulmonary disease in primary care records. They can be used to enable further studies in practice patterns and chronic obstructive pulmonary disease management in primary care. NOVEL ALGORITHM SEARCH TECHNIQUE: Researchers develop an algorithm that can accurately search through electronic health records to find patients with chronic lung disease. Mining population-wide data for information on patients diagnosed and treated with chronic obstructive pulmonary disease (COPD) in primary care could help inform future healthcare and spending practices. Theresa Lee at the University of Toronto, Canada, and colleagues used an algorithm to search electronic medical records and identify patients with COPD from doctors' notes, prescriptions and symptom histories. They carefully adjusted the algorithm to improve sensitivity and predictive value by adding details such as specific medications, physician codes related to COPD, and different combinations of terminology in doctors' notes. The team accurately identified 364 patients with COPD in a randomly-selected cohort of 5889 people. Their results suggest opportunities for broader, informative studies of COPD in wider populations.

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. Copyright 2013, SLACK Incorporated.

Using the electronic medical record to assess contraception usage among women taking category D or X medications.

PubMed

Mody, Sheila K; Farala, John Paul; Wu, Jennifer; Felix, Robert; Chambers, Christina

2015-10-01

The aim of this study is to investigate contraceptive usage among women prescribed or currently taking a category D or X medication using the electronic medical record. This is a retrospective study assessing contraceptive usage among women prescribed category D or X medications. We obtained access to the electronic medical records of women seen in an academic Family Medicine Department between April 2011 and April 2012 who were prescribed a category D or X medication. Information was abstracted regarding the specific category D or X medication, demographics, sexual activity, sexual partner gender, and contraceptive usage. There were a total of 610 women included in this study. Among the 610 women, 72 (11.8%) of women had documentation that they were not asked about their sexual activity. Sexual activity with men was documented in 407 of the 610 women (66.7%). Of these 407 women, 132 (32.4%) had no contraceptive method documented. Among the women using contraception, the most common method used was oral contraception. According to data obtained from the electronic medical record, women who are taking a category D or X medication are not always asked about sexual activity. Contraception usage among women taking category D or X medications and who were sexually active with men was similar to the general population. Contraception usage should be better in this population given the risk of an unintended pregnancy includes fetal exposure to a potential teratogen. The electronic medical record creates an opportunity for an intervention to increase contraception utilization in this population. © 2015 Wiley Periodicals, Inc.

Using the Electronic Medical Record to Assess Contraception Usage among Women Taking Category D or X Medications

PubMed Central

Mody, Sheila K; Farala, John Paul; Wu, Jennifer; Felix, Robert; Chambers, Christina

2016-01-01

Background The aim of this study is to investigate contraceptive usage among women prescribed or currently taking a category D or X medication using the electronic medical record. Methods This is a retrospective study assessing contraceptive usage among women prescribed category D or X medications. We obtained access to the electronic medical records of women seen in an academic Family Medicine Department between April 2011 and April 2012 who were prescribed a category D or X medication. Information was abstracted regarding the specific category D or X medication, demographics, sexual activity, sexual partner gender, and contraceptive usage. Results There were a total of 610 women included in this study. Among the 610 women, 72 (11.8%) of women had documentation that they were not asked about their sexual activity. Sexual activity with men was documented in 407 of the 610 women (66.7%). Of these 407 women, 132 (32.4%) had no contraceptive method documented. Among the women using contraception, the most common method used was oral contraception. Conclusion According to data obtained from the electronic medical record, women who are taking a category D or X medication are not always asked about sexual activity. Contraception usage among women taking category D or X medications and who were sexually active with men was similar to the general population. Contraception usage should be better in this population given the risk of an unintended pregnancy includes fetal exposure to a potential teratogen. The electronic medical record creates an opportunity for an intervention to increase contraception utilization in this population. PMID:26306028

Prevalence and usage of printed and electronic drug references and patient medication records in community pharmacies in Malaysia.

PubMed

Usir, Ezlina; Lua, Pei Lin; Majeed, Abu Bakar Abdul

2012-06-01

This study aimed to determine the availability and usage of printed and electronic references and Patient Medication Record in community pharmacy. It was conducted for over 3 months from 15 January to 30 April 2007. Ninety-three pharmacies participated. Structured questionnaires were mailed to community pharmacies. Six weeks later a reminder was sent to all non responders, who were given another six weeks to return the completed questionnaire. Outcomes were analyzed using descriptive statistics and chi-square test of independence. Almost all the pharmacies (96.8%) have at least Monthly Index of Medical Specialties (MIMS) while 78.5% have at least MIMS ANNUAL in their stores. Only about a third (31.2%) of the pharmacies were equipped with online facilities of which the majority referred to medical websites (88.9%) with only a minority (11.1%) referring to electronic journals. More than half (59.1%) of the pharmacists kept Patient Medication Record profiles with 49.1% storing it in paper, 41.8% electronically and 9.1% in both printed and electronic versions. In general, prevalence and usage of electronic references in community pharmacies were rather low. Efforts should be increased to encourage wider usage of electronic references and Patient Medication Records in community pharmacies to facilitate pharmaceutical care.

MedlinePlus Connect: Linking Patient Portals and Electronic Health Records to Health Information

MedlinePlus

... Patient portals, patient health record (PHR) systems, and electronic health record (EHR) systems can use MedlinePlus Connect ... patient portal, patient health record (PHR) system, or electronic health record (EHR) system sends a problem, medication, ...

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. © The Author(s) 2015.

75 FR 64749 - Request for Comments on the Use of Electronic Signatures for NRC Documents Related to the Medical...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-20

... medical records by 2014. The U.S. Nuclear Regulatory Commission (NRC) is seeking public comment on... Regulations (CFR) 35.40 and records for inspection required by 10 CFR part 35 subpart L). For medical use licensees, 10 CFR 35.5 permits the use of electronic media to produce and store records that are maintained...

Are In-Bed Electronic Weights Recorded in the Medical Record Accurate?

PubMed

Gerl, Heather; Miko, Alexandra; Nelson, Mandy; Godaire, Lori

2016-01-01

This study found large discrepancies between in-bed weights recorded in the medical record and carefully obtained standing weights with a calibrated, electronic bedside scale. This discrepancy appears to be related to inadequate bed calibration before patient admission and having excessive linen, clothing, and/or equipment on the bed during weighing by caregivers.

Integrated Electronic Health Record Database Management System: A Proposal.

PubMed

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

2015-01-01

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

Electronic hand-drafting and picture management system.

PubMed

Yang, Tsung-Han; Ku, Cheng-Yuan; Yen, David C; Hsieh, Wen-Huai

2012-08-01

The Department of Health of Executive Yuan in Taiwan (R.O.C.) is implementing a five-stage project entitled Electronic Medical Record (EMR) converting all health records from written to electronic form. Traditionally, physicians record patients' symptoms, related examinations, and suggested treatments on paper medical records. Currently when implementing the EMR, all text files and image files in the Hospital Information System (HIS) and Picture Archiving and Communication Systems (PACS) are kept separate. The current medical system environment is unable to combine text files, hand-drafted files, and photographs in the same system, so it is difficult to support physicians with the recording of medical data. Furthermore, in surgical and other related departments, physicians need immediate access to medical records in order to understand the details of a patient's condition. In order to address these problems, the Department of Health has implemented an EMR project, with the primary goal of building an electronic hand-drafting and picture management system (HDP system) that can be used by medical personnel to record medical information in a convenient way. This system can simultaneously edit text files, hand-drafted files, and image files and then integrate these data into Portable Document Format (PDF) files. In addition, the output is designed to fit a variety of formats in order to meet various laws and regulations. By combining the HDP system with HIS and PACS, the applicability can be enhanced to fit various scenarios and can assist the medical industry in moving into the final phase of EMR.

Auditing The Completeness and Legibility of Computerized Radiological Request Forms.

PubMed

Al Muallem, Yahya; Al Dogether, Majed; Househ, Mowafa; Saddik, Basema

2017-11-04

Certain Saudi healthcare organizations transfer outpatients to medical imaging departments for radiological examinations in a manual process that relies on the use of paper-based forms. With the increased implementation of electronic medical records in Saudi Hospitals, little is known about the completeness and legibility of information captured in  electronic-based medical imaging forms. The purpose of this study is to audit the completeness and legibility of medical imaging paper-based forms in comparison with electronic-based medical imaging forms. As a secondary objective, we also examined the number of errors found on the forms.An observational retrospective cross-sectional study was utilized to audit the completeness and legibility of both paper and electronic forms collected between March 1 and May 15, 2015. The study measured the association among categorical variables using Chi-Square analysis. The results of this investigation show a significant association between form completion and type of record (i.e., paper vs. electronic) where electronic-based systems were found to be more complete than paper-based records. Electrnoic based records were also found to improve form legibility, promote user adherence to complete the forms and minimize entry errors. In conclusion, electronic-based medical imaging forms are more complete and legible than paper based forms. Future studies should evaluate other hospitals and compare both legibility and completeness of electronic-based medical imaging forms and conduct usability evaluation studies with users to explore the impacts of system design on both completeness and legibility of electronic forms, in general, but more specifically, electronic-based medical imaging forms.

Perspectives of healthcare practitioners: An exploration of interprofessional communication using electronic medical records.

PubMed

Bardach, Shoshana H; Real, Kevin; Bardach, David R

2017-05-01

Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners' experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record, and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one's notes. Limitations in technology-including limited computer availability, documentation complexity, and sluggish sign-in processes-also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardised electronic medical record use across professions at the optimal level to support communication and patient care.

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

ERIC Educational Resources Information Center

Slaughter, Andre

2017-01-01

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

Health Care Personnel Perception of the Privacy of Electronic Health Records.

PubMed

Saito, Kenji; Shofer, Frances S; Saberi, Poune; Green-McKenzie, Judith

2017-06-01

: Health care facilities are increasingly converting paper medical records to electronic health records. This study investigates the perception of privacy health care personnel have of electronic health records. A pilot tested, anonymous survey was administered to a convenience sample of health care personnel. Standard summary statistics and Chi-square analysis were used to assess differences in perception. Of the 93% (96/103) who responded, 65% were female and 43% white. The mean age was 44.3 years. Most (94%) felt that Medical Record privacy was important and one-third reported they would not seek care at their workplace if Electronic Health Records were used. Efforts to assure and communicate the integrity of electronic health records are essential toward reducing deterrents for health care personnel to access geographically convenient and timely health care.

Implementation of standardized nomenclature in the electronic medical record.

PubMed

Klehr, Joan; Hafner, Jennifer; Spelz, Leah Mylrea; Steen, Sara; Weaver, Kathy

2009-01-01

To describe a customized electronic medical record documentation system which provides an electronic health record, Epic, which was implemented in December 2006 using standardized taxonomies for nursing documentation. Descriptive data is provided regarding the development, implementation, and evaluation processes for the electronic medical record system. Nurses used standardized nursing nomenclature including NANDA-I diagnoses, Nursing Interventions Classification, and Nursing Outcomes Classification in a measurable and user-friendly format using the care plan activity. Key factors in the success of the project included close collaboration among staff nurses and information technology staff, ongoing support and encouragement from the vice president/chief nursing officer, the ready availability of expert resources, and nursing ownership of the project. Use of this evidence-based documentation enhanced institutional leadership in clinical documentation.

A high-level object-oriented model for representing relationships in an electronic medical record.

PubMed Central

Dolin, R. H.

1994-01-01

The importance of electronic medical records to improve the quality and cost-effectiveness of medical care continues to be realized. This growing importance has spawned efforts at defining the structure and content of medical data, which is heterogeneous, highly inter-related, and complex. Computer-assisted data modeling tools have greatly facilitated the process of representing medical data, however the complex inter-relationships of medical information can result in data models that are large and cumbersome to manipulate and view. This report presents a high-level object-oriented model for representing the relationships between objects or entities that might exist in an electronic medical record. By defining the relationship between objects at a high level and providing for inheritance, this model enables relating any medical entity to any other medical entity, even though the relationships were not directly specified or known during data model design. PMID:7949981

Assessing explicit error reporting in the narrative electronic medical record using keyword searching.

PubMed

Cao, Hui; Stetson, Peter; Hripcsak, George

2003-01-01

In this study, we assessed the explicit reporting of medical errors in the electronic record. We looked for cases in which the provider explicitly stated that he or she or another provider had committed an error. The advantage of the technique is that it is not limited to a specific type of error. Our goals were to 1) measure the rate at which medical errors were documented in medical records, and 2) characterize the types of errors that were reported.

Achieving meaningful use: a health system perspective.

PubMed

Bero, Cynthia L; Lee, Thomas H

2010-12-01

In 2002, Partners HealthCare (Partners) launched a strategy to accelerate the use of ambulatory electronic medical records across its network of 6000 physicians. Through focus on quality software products, creation of a system of financial incentives, and active engagement of health system leadership, Partners reached high levels of physician adoption by late 2006. Partners eventually introduced a mandate that made ambulatory electronic medical record use a requirement for all of its physicians. During this multi-year initiative, Partners also focused on the effective use of electronic medical records and introduced a series of tactics designed to optimize the use of these systems. With introduction of the meaningful-use concepts in the Health Information Technology for Economic and Clinical Health (HITECH) Act, Partners will transition its efforts toward this important national priority. Partners' experience offers some unique insights into the process of electronic medical record adoption across a large, diverse health system.

A survey-based study of factors that motivate nurses to protect the privacy of electronic medical records.

PubMed

Ma, Chen-Chung; Kuo, Kuang-Ming; Alexander, Judith W

2016-02-02

The purpose of this study is to investigate factors that motivate nurses to protect privacy in electronic medical records, based on the Decomposed Theory of Planned Behavior. This cross-sectional study used questionnaires to collect data from nurses in a large tertiary care military hospital in Taiwan. The three hundred two (302) valid questionnaires returned resulted in a response rate of 63.7 %. Structural equation modeling identified that the factors of attitude, subjective norm, and perceived behavioral control of the nurses significantly predicted the nurses' intention to protect the privacy of electronic medical records. Further, perceived usefulness and compatibility, peer and superior influence, self-efficacy and facilitating conditions, respectively predicted these three factors. The results of our study may provide valuable information for education and practice in predicting nurses' intention to protect privacy of electronic medical records.

The role of frontline RNs in the selection of an electronic medical record business partner.

PubMed

Wilhoit, Kathryn; Mustain, Jane; King, Marjorie

2006-01-01

Frontline RNs knowledgeable in the strategic objectives of their organization made a difference in the selection of an electronic medical record business partner for a large, complex healthcare system. Their impact was significant because of the chief nurse executive's personal articulation of the organization's strategic goals and of her investment in their education. These factors provided the frontline RNs with a foundational base of knowledge about a variety of electronic medical record systems. The preparation and exposure enabled the frontline RNs to make a valuable contribution to the selection of an electronic medical record business partner. The RNs were a major force in affecting philosophical change from the organization's original pursuit of "best-of-breed" interfaced systems to a fully integrated, "best-of-class" vendor business partner. The learning experiences of the frontline RNs are explored to answer the following question: Why must frontline RNs play a key role in this process?

A Delphi Study Assessing Long-Term Access to Electronic Medical Records (EMR)

DTIC Science & Technology

2008-03-01

Americans surveyed would prefer physicians and insurance companies that use electronic medical records to those that do not (Swartz, 2007). Based on...procedures performed or medication(s) issued for health history and insurance purposes. A large portion of a physician’s workday is consumed with...disconnect existed between the Social Uses Life/Health Insurance Employment/Licensing Public Health Medical Research Social/Welfare Programs Law

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…

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

PubMed

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

2018-02-01

Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital's current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records. This causes inefficiencies in the recall of patient information and can potentially lead to incidences of adverse drug events. What does this paper add? This paper supports the concept of a shared medical record system using 200 audited patient records across five Victorian metropolitan hospitals, comparing the current information systems in place for healthcare practitioners to retrieve data. This research identifies the degree of concordance between these sources of information and in doing so, areas for improvement. What are the implications for practitioners? Implications of this research are the improvements in the quality, storage and accessibility of medical data in Australian healthcare systems. This is a relevant issue in the current Australian environment where no guidelines exist across the board in medical history documentation or in the distribution of discharge summaries to other healthcare providers (general practitioners, etc).

A Mis-recognized Medical Vocabulary Correction System for Speech-based Electronic Medical Record

PubMed Central

Seo, Hwa Jeong; Kim, Ju Han; Sakabe, Nagamasa

2002-01-01

Speech recognition as an input tool for electronic medical record (EMR) enables efficient data entry at the point of care. However, the recognition accuracy for medical vocabulary is much poorer than that for doctor-patient dialogue. We developed a mis-recognized medical vocabulary correction system based on syllable-by-syllable comparison of speech text against medical vocabulary database. Using specialty medical vocabulary, the algorithm detects and corrects mis-recognized medical vocabularies in narrative text. Our preliminary evaluation showed 94% of accuracy in mis-recognized medical vocabulary correction.

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

PubMed

Chen, Wei; Shih, Chien-Chou

2012-02-01

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

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

... Access to VHA Electronic Health Records) Activity; Comment Request AGENCY: Veterans Health Administration... Access to VHA Electronic Health Records, VA Form 10- 0400. OMB Control Number: 2900-0710. Type of Review... were granted power of attorney by veterans who have medical information recorded in VHA electronic...

The use of a fully integrated electronic medical record to minimize cumulative lifetime radiation exposure from CT scanning to detect urinary tract calculi.

PubMed

Kohler, Steven W; Chen, Richard; Kagan, Alex; Helvey, Dustin W; Buccigrossi, David

2013-06-01

In order to determine the effects of implementation of an electronic medical record on rates of repeat computed tomography (CT) scanning in the emergency department (ED) setting, we analyzed the utilization of CT of the kidneys, ureters, and bladder (CT KUB) for the detection of urinary tract calculi for periods before and after the implementation of a hospital-wide electronic medical record system. Rates of repeat CT scanning within a 6-month period of previous scan were determined pre- and post-implementation and compared. Prior to implementation, there was a 6-month repeat rate of 6.2 % compared with the post-implementation period, which was associated with a 6-month repeat rate of 4.1 %. Statistical analysis using a two-sample, one-tailed t test for difference of means was associated with a p value of 0.00007. This indicates that the implementation of the electronic medical record system was associated with a 34 % decrease in 6-month repeat CT KUB scans. We conclude that the use of an electronic medical record can be associated with a decrease in utilization of unnecessary repeat CT imaging, leading to decreased cumulative lifetime risk for cancer in these patients and more efficient utilization of ED and radiologic resources.

Factors Influencing the Adoption of Electronic Medical Records: Phenomenological Study of Physicians in Private Practice

ERIC Educational Resources Information Center

Backherms, Dennis A.

2017-01-01

Information technology has become increasingly necessary for competition in the 21st century. The medical industry has taken on a more comprehensive approach by creating and adopting different types of electronic medical records (EMR). Laws and regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) or the Meaningful…

Medical providers' dental information needs: a baseline survey.

PubMed

Acharya, Amit; Mahnke, Andrea; Chyou, Po-Huang; Rottscheit, Carla; Starren, Justin B

2011-01-01

Articulation of medical and dental practices has been strongly called for based on the many oral-systemic connections. With the rapid development and adoption of electronic health records, the feasibility of integrating medical and dental patient data should be strongly considered. The objective of this study was to develop an initial understanding of the medical providers' core dental information needs and opinion of integrated medical-dental electronic health record (iEHR) environment in their workflow. This was achieved by administering a 13 question survey to a group of 1,197 medical care providers employed by Marshfield Clinic in Wisconsin, United States. The survey received a response rate of 35%. The responses were analyzed based on provider 'Role' and 'Specialty'. The majority of the respondents felt the need for patient's dental information to coordinate or provide effective medical care. An integrated electronic health record environment could facilitate this holistic patient care approach.

Dutch virtual integration of healthcare information.

PubMed

de Graaf, J C; Vlug, A E; van Boven, G J

2007-01-01

As information technology creates opportunities for cooperation which crosses the boundaries between healthcare institutions, it will become an integral part of the Dutch healthcare system. Along with many involved organizations in healthcare the National IT Institute for Healthcare in the Netherlands (NICTIZ) is working on the realization of a national IT infrastructure for healthcare and a national electronic patient record (EPR). An underlying national architecture is designed to enable the Dutch EPR virtually, not in a national database, nor on a patient's smartcard. The required secure infrastructure provides generic functions for healthcare applications: patient identification, authentication and authorization of healthcare professionals. The first national applications in the EPR program using a national index of where patient data is stored, are the electronic medication record and the electronic record for after hours GP services. The rollout of the electronic medication record and electronic record for after hours GP services has been started in 2007. To guarantee progress of electronic data exchange in healthcare in the Netherlands we have primarily opted for two healthcare applications: the electronic medication record and the electronic record for after hours GP services. The use of a national switch-point containing the registry of where to find what information, guarantees that the professional receives the most recent information and omits large databases to contain downloaded data. Proper authorization, authentication as well as tracing by the national switchpoint also ensures a secure environment for the communication of delicate information.

Separate may not be equal: A preliminary investigation of clinical correlates of electronic psychiatric record accessibility in academic medical centers

PubMed Central

Kozubal, Dana E.; Samus, Quincy M.; Bakare, Aishat A.; Trecker, Carrilin C.; Wong, Hei-Wah; Guo, Huiying; Cheng, Jeffrey; Allen, Paul X.; Mayer, Lawrence S.; Jamison, Kay R.; Kaplin, Adam I.

2014-01-01

Objectives Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. Methods Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible to non-psychiatric physicians. Electronic hospital records and accessibility statuses were correlated with patient care outcomes obtained from the University Health System Consortium Clinical Database available for 13 of the 18 top US hospitals. Results 44% of hospitals surveyed maintained most or all of their psychiatric records electronically and 28% made psychiatric records accessible to non-psychiatric physicians; only 22% did both. Compared with hospitals where psychiatric records were not stored electronically, the average 7-day readmission rate of psychiatric patients was significantly lower at hospitals with psychiatric EMR (5.1% vs. 7.0%, p = .040). Similarly, the 14 and 30-day readmission rates at hospitals where psychiatric records were accessible to non-psychiatric physicians were lower than those of their counterparts with non-accessible records (5.8% vs. 9.5%, p = .019, 8.6% vs. 13.6%, p = .013, respectively). The 7, 14, and 30-day readmission rates were significantly lower in hospitals where psychiatric records were both stored electronically and made accessible than at hospitals where records were either not electronic or not accessible (4% vs 6.6%, 5.8% vs 9.1%, 8.9 vs 13%, respectively, all with p = 0.045). Conclusions Having psychiatric EMR that were accessible to non-psychiatric physicians correlated with improved clinical care as measured by lower readmission rates specific for psychiatric patients. PMID:23266060

Integration of multiple DICOM Web servers into an enterprise-wide Web-based electronic medical record

NASA Astrophysics Data System (ADS)

Stewart, Brent K.; Langer, Steven G.; Martin, Kelly P.

1999-07-01

The purpose of this paper is to integrate multiple DICOM image webservers into the currently existing enterprises- wide web-browsable electronic medical record. Over the last six years the University of Washington has created a clinical data repository combining in a distributed relational database information from multiple departmental databases (MIND). A character cell-based view of this data called the Mini Medical Record (MMR) has been available for four years, MINDscape, unlike the text-based MMR. provides a platform independent, dynamic, web browser view of the MIND database that can be easily linked with medical knowledge resources on the network, like PubMed and the Federated Drug Reference. There are over 10,000 MINDscape user accounts at the University of Washington Academic Medical Centers. The weekday average number of hits to MINDscape is 35,302 and weekday average number of individual users is 1252. DICOM images from multiple webservers are now being viewed through the MINDscape electronic medical record.

76 FR 56503 - Agency Information Collection Activity (VSO Access to VHA Electronic Health Records) Under OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... power of attorney by veterans who have medical information recorded in VHA electronic health records... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0710] Agency Information Collection Activity (VSO Access to VHA Electronic Health Records) Under OMB Review AGENCY: Veterans Health Administration...

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

PubMed

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

2001-01-01

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

Knowledge management for the protection of information in electronic medical records.

PubMed

Lea, Nathan; Hailes, Stephen; Austin, Tony; Kalra, Dipak

2008-01-01

This paper describes foundational work investigating the protection requirements of sensitive medical information, which is being stored more routinely in repository systems for electronic medical records. These systems have increasingly powerful sharing capabilities at the point of clinical care, in medical research and for clinical and managerial audit. The potential for sharing raises concerns about the protection of individual patient privacy and challenges the duty of confidentiality by which medical practitioners are ethically and legally bound. By analysing the protection requirements and discussing the need to apply policy-based controls to discrete items of medical information in a record, this paper suggests that this is a problem for which existing privacy management solutions are not sufficient or appropriate to the protection requirements. It proposes that a knowledge management approach is required and it introduces a new framework based on the knowledge management techniques now being used to manage electronic medical record data. The background, existing work in this area, initial investigation methods, results to date and discussion are presented, and the paper is concluded with the authors' comments on the ramifications of the work.

The need to incorporate health information technology into physicians' education and professional development.

PubMed

Graham-Jones, Pierce; Jain, Sachin H; Friedman, Charles P; Marcotte, Leah; Blumenthal, David

2012-03-01

Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.

Compliance With Electronic Medical Records Privacy Policy: An Empirical Investigation of Hospital Information Technology Staff

PubMed Central

Sher, Ming-Ling; Talley, Paul C.; Yang, Ching-Wen; Kuo, Kuang-Ming

2017-01-01

The employment of Electronic Medical Records is expected to better enhance health care quality and to relieve increased financial pressure. Electronic Medical Records are, however, potentially vulnerable to security breaches that may result in a rise of patients’ privacy concerns. The purpose of our study was to explore the factors that motivate hospital information technology staff’s compliance with Electronic Medical Records privacy policy from the theoretical lenses of protection motivation theory and the theory of reasoned action. The study collected data using survey methodology. A total of 310 responses from information technology staff of 7 medical centers in Taiwan was analyzed using the Structural Equation Modeling technique. The results revealed that perceived vulnerability and perceived severity of threats from Electronic Medical Records breaches may be used to predict the information technology staff’s fear arousal level. And factors including fear arousal, response efficacy, self-efficacy, and subjective norm, in their turn, significantly predicted IT staff’s behavioral intention to comply with privacy policy. Response cost was not found to have any relationship with behavioral intention. Based on the findings, we suggest that hospitals could plan and design effective strategies such as initiating privacy-protection awareness and skills training programs to improve information technology staff member’s adherence to privacy policy. Furthermore, enhancing the privacy-protection climate in hospitals is also a viable means to the end. Further practical and research implications are also discussed.

Preparing for Electronic Medical Record Implementation: Carolina Care Communication in an Electronic Environment.

PubMed

Carroll, Tracy; Tonges, Mary; Ray, Joel

2017-11-01

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the "Communication in an Electronic Environment" program with a strong emphasis on nurse-patient communication.

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

PubMed

Russell, Matthew

2011-09-01

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

The work practice of medical secretaries and the implementation of electronic health records in Denmark.

PubMed

Bertelsen, Pernille; Nøhr, Christian

The introduction of electronic health records will entail substantial organisational changes to the clinical and administrative staff in hospitals. Hospital owners in Denmark have predicted that these changes will render up to half of medical secretaries redundant. The present study however shows that medical secretaries have a great variety of duties, and often act as the organisational "glue" or connecting thread between other professional groups at the hospital. The aim of this study is to obtain a detailed understanding of the pluralism of work tasks the medical secretaries perform. It is concluded that clinicians as well as nurses depend on medical secretaries, and therefore to reduce the number of secretaries because electronic health record systems are implemented needs very careful thinking, planning and discussion with the other professions involved.

Patients' consent preferences for research uses of information in electronic medical records: interview and survey data.

PubMed

Willison, Donald J; Keshavjee, Karim; Nair, Kalpana; Goldsmith, Charlie; Holbrook, Anne M

2003-02-15

To assess patients' preferred method of consent for the use of information from electronic medical records for research. Interviews and a structured survey of patients in practices with electronic medical records. Family practices in southern Ontario, Canada. 123 patients: 17 were interviewed and 106 completed a survey. Patients' opinions and concerns on use of information from their medical records for research and their preferences for method of consent. Most interviewees were willing to allow the use of their information for research purposes, although the majority preferred that consent was sought first. The seeking of consent was considered an important element of respect for the individual. Most interviewees made little distinction between identifiable and anonymised data. Research sponsored by private insurance firms generated the greatest concern, and research sponsored by foundation the least. Sponsorship by drug companies evoked negative responses during interview and positive responses in the survey. Patients are willing to allow information from their medical records to be used for research, but most prefer to be asked for consent either verbally or in writing.

Privacy preserving index for encrypted electronic medical records.

PubMed

Chen, Yu-Chi; Horng, Gwoboa; Lin, Yi-Jheng; Chen, Kuo-Chang

2013-12-01

With the development of electronic systems, privacy has become an important security issue in real-life. In medical systems, privacy of patients' electronic medical records (EMRs) must be fully protected. However, to combine the efficiency and privacy, privacy preserving index is introduced to preserve the privacy, where the EMR can be efficiently accessed by this patient or specific doctor. In the literature, Goh first proposed a secure index scheme with keyword search over encrypted data based on a well-known primitive, Bloom filter. In this paper, we propose a new privacy preserving index scheme, called position index (P-index), with keyword search over the encrypted data. The proposed index scheme is semantically secure against the adaptive chosen keyword attack, and it also provides flexible space, lower false positive rate, and search privacy. Moreover, it does not rely on pairing, a complicate computation, and thus can search over encrypted electronic medical records from the cloud server efficiently.

Incidence and cost of medications dispensed despite electronic medical record discontinuation.

PubMed

Baranowski, Patrick J; Peterson, Kristin L; Statz-Paynter, Jamie L; Zorek, Joseph A

2015-01-01

To determine the incidence and cost of medications dispensed despite discontinuation (MDDD) of the medications in the electronic medical record within an integrated health care organization. Dean Health System, with medical clinics and pharmacies linked by an electronic medical record, and a shared health plan and pharmacy benefits management company. Pharmacist-led quality improvement project using retrospective chart review. Electronic medical records, pharmacy records, and prescription claims data from patients 18 years of age or older who had a prescription filled for a chronic condition from June 2012 to August 2013 and submitted a claim through the Dean Health Plan were aggregated and cross-referenced to identify MDDD. Descriptive statistics were used to characterize demographics and MDDD incidence. Fisher's exact test and independent samples t tests were used to compare MDDD and non-MDDD groups. Wholesale acquisition cost was applied to each MDDD event. 7,406 patients met inclusion criteria. For 223 (3%) patients with MDDD, 253 independent events were identified. In terms of frequency per category, antihypertensive agents topped the list, followed, in descending order, by anticonvulsants, antilipemics, antidiabetics, and anticoagulants. Nine medications accounted for 59% (150 of 253) of all MDDD events; these included (again in descending order): gabapentin, atorvastatin, simvastatin, hydrochlorothiazide, lisinopril, warfarin, furosemide, metformin, and metoprolol. Mail-service pharmacies accounted for the highest incidence (5.3%) of MDDD, followed by mass merchandisers (4.6%) and small chains (3.9%). The total cost attributable to MDDD was $9,397.74. Development of a technology-based intervention to decrease the incidence of MDDD may be warranted to improve patient safety and decrease health care costs.

Physician Sensemaking and Readiness for Electronic Medical Records

ERIC Educational Resources Information Center

Riesenmy, Kelly Rouse

2010-01-01

Purpose: The purpose of this paper is to explore physician sensemaking and readiness to implement electronic medical records (EMR) as a first step to finding strategies that enhance EMR adoption behaviors. Design/methodology/approach: The case study approach provides a detailed analysis of individuals within an organizational unit. Using a…

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…

Pharmacist-led admission medication reconciliation before and after the implementation of an electronic medication management system.

PubMed

Sardaneh, Arwa A; Burke, Rosemary; Ritchie, Angus; McLachlan, Andrew J; Lehnbom, Elin C

2017-05-01

To investigate the impact of the introduction of an electronic medication management system on the proportion of patients with a recorded medication reconciliation on admission, the time from admission to when medication reconciliation was performed, and the characteristics of patients receiving this intervention pre-and post-implementation. An electronic medication management system was implemented in an Australian hospital from May to July 2015. A retrospective observational study was conducted in three wards across two phases; pre- (August 2014) and post- (August 2015) implementation. The study sample included every second patient admitted to these wards. A total of 370 patients were included, 179 pre- and 191 post-implementation. The proportion of recorded admission medication reconciliation significantly increased post-implementation in all study wards; coronary care unit (40 vs 68%, p=0.004), gastroenterology ward (39 vs 59%, p=0.015), and the neurology ward (19 vs 45%, p=0.002). The proportion of patients with recorded medication reconciliation within 24h of weekday admissions, or 48-72h of weekend admissions, increased from 47% pre- to 84% post-implementation. Admission medication reconciliation was recorded within a median of 1.0day for weekday admissions pre- and post-implementation (IQR 1.1 vs 0.2, respectively), and 3.5days (IQR 2.0) pre-implementation vs 1.5days (IQR 2.0) post-implementation for weekend admissions. Overall, across both phases pre-and post-implementation, admission medication reconciliation was recorded for patients who were significantly older (median 77 and 71 years, p<0.001), had a higher number of preadmission medications (median 6.5 and 5.0 medicines, p=0.001), and had a longer hospital stay (median 6.5 and 5.1days, p=0.003). A significantly higher proportion of patients with recorded medication reconciliation in the pre-implementation phase experienced polypharmacy (61%, p=0.002), hyperpolypharmacy (15%, p=0.001), and used a high-risk medication (44%, p=0.007). Implementing an electronic medication management system facilitates the medication reconciliation process leading to more high risk patients receiving this service on admission to hospital and in a more timely manner. The impact of electronic medication reconciliation on patient safety and clinical outcomes remains unknown. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2015-08-01

There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document Architecture (CDA) standards to generate clinical documents and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS) profile for the communication infrastructure. By December of 2014, the number of hospitals that provide an inter-institution EMR exchange service had reached 321. Hospitals that had not joined the service were all smaller ones with less than 100 beds. Inter-institution EMR exchange can make it much easier for people to access their own medical records, reduce the waste of medical resources, and improve the quality of medical care. The implementation of an inter-institution EMR exchange system faces many challenges. This article provides Taiwan's experiences as a reference. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

An Efficient Searchable Encryption Against Keyword Guessing Attacks for Sharable Electronic Medical Records in Cloud-based System.

PubMed

Wu, Yilun; Lu, Xicheng; Su, Jinshu; Chen, Peixin

2016-12-01

Preserving the privacy of electronic medical records (EMRs) is extremely important especially when medical systems adopt cloud services to store patients' electronic medical records. Considering both the privacy and the utilization of EMRs, some medical systems apply searchable encryption to encrypt EMRs and enable authorized users to search over these encrypted records. Since individuals would like to share their EMRs with multiple persons, how to design an efficient searchable encryption for sharable EMRs is still a very challenge work. In this paper, we propose a cost-efficient secure channel free searchable encryption (SCF-PEKS) scheme for sharable EMRs. Comparing with existing SCF-PEKS solutions, our scheme reduces the storage overhead and achieves better computation performance. Moreover, our scheme can guard against keyword guessing attack, which is neglected by most of the existing schemes. Finally, we implement both our scheme and a latest medical-based scheme to evaluate the performance. The evaluation results show that our scheme performs much better performance than the latest one for sharable EMRs.

Computer-Based Medical System

NASA Technical Reports Server (NTRS)

1998-01-01

SYMED, Inc., developed a unique electronic medical records and information management system. The S2000 Medical Interactive Care System (MICS) incorporates both a comprehensive and interactive medical care support capability and an extensive array of digital medical reference materials in either text or high resolution graphic form. The system was designed, in cooperation with NASA, to improve the effectiveness and efficiency of physician practices. The S2000 is a MS (Microsoft) Windows based software product which combines electronic forms, medical documents, records management, and features a comprehensive medical information system for medical diagnostic support and treatment. SYMED, Inc. offers access to its medical systems to all companies seeking competitive advantages.

Automating concept identification in the electronic medical record: an experiment in extracting dosage information.

PubMed Central

Evans, D. A.; Brownlow, N. D.; Hersh, W. R.; Campbell, E. M.

1996-01-01

We discuss the development and evaluation of an automated procedure for extracting drug-dosage information from clinical narratives. The process was developed rapidly using existing technology and resources, including categories of terms from UMLS96. Evaluations over a large training and smaller test set of medical records demonstrate an approximately 80% rate of exact and partial matches' on target phrases, with few false positives and a modest rate of false negatives. The results suggest a strategy for automating general concept identification in electronic medical records. PMID:8947694

Ambulatory electronic medical record payback analysis 7 years after implementation in a tertiary care county medical system.

PubMed

Kaelber, David C; Miller, Vince; Fisher, Nancy; Schlesinger, Jim; Norris, Greg

2007-10-11

Electronic medical records (EMRs) are gaining increasing prominence in healthcare, however still have low market penetration. EMR implementation cost is a primary perceived barrier. Here we present a payback analysis on an outpatient EMR implementation, showing capital expense recovery (net of operating costs) at 6 years and now generating $6 million yearly in direct savings for our healthcare system.

77 FR 23193 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2; Corrections

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... for electronic medication administration record (eMAR). In addition, in Sec. 495.6(m)(1)(iii) we... description contact information TBD Title: Closing the referral loop: Centers for Medicare Care Coordination... corrected to read ``(ii) Measure. More than 10 percent of medication orders created by authorized providers...

An Evaluation of Authentic Learning in an Electronic Medical Records System

ERIC Educational Resources Information Center

Stuart, Sandra L.

2013-01-01

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

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…

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

ERIC Educational Resources Information Center

Aldukheil, Maher A.

2013-01-01

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

[Qualitative evaluation of blood products records in a hospital].

PubMed

Lartigue, B; Catillon, E

2012-02-01

This study aimed at evaluating the qualitative performance of blood products traceability from paper and electronic medical records in a hospital. Quality of date/time documentation was assessed by detection, for 20minutes or more, of chronological errors and inter-source inconsistencies, in a random sample of 168 blood products transfused during 2009. A receipt date/time was confirmed in 52% of paper records; a data entry error was attested in 25% of paper records, and 21% of electronic records. A transfusion date/time was notified in 93% of paper records, with a data entry error in 26% of paper records and 25% of electronic records. The patient medical record held at least one date/time error in 18% and 17%, for receipt and transfusion respectively. Environmental factors (clinical setting, urgency, blood product category) did not contributed to data error rates. Although blood products traceability has good quantitative results, the recorded documentation is not qualitative. In our study, data entry errors are similar in electronic or paper records, but the global failure rate is lesser in electronic records because omissions are controlled. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

UCare navigator: A dynamic guide to the hybrid electronic and paper medical record in transition.

PubMed

Bokser, Seth J; Cucina, Russell J; Love, Jeffrey S; Blum, Michael S

2007-10-11

During the phased transition from a paper-based record to an electronic health record (EHR), we found that clinicians had difficulty remembering where to find important clinical documents. We describe our experience with the design and use of a web-based map of the hybrid medical record. With between 50 to 75 unique visits per day, the UCare Navigator has served as an important aid to clinicians practicing in the transitional environment of a large EHR implementation.

Processing medical data: a systematic review

PubMed Central

2013-01-01

Background Medical data recording is one of the basic clinical tools. Electronic Health Record (EHR) is important for data processing, communication, efficiency and effectiveness of patients’ information access, confidentiality, ethical and/or legal issues. Clinical record promote and support communication among service providers and hence upscale quality of healthcare. Qualities of records are reflections of the quality of care patients offered. Methods Qualitative analysis was undertaken for this systematic review. We reviewed 40 materials Published from 1999 to 2013. We searched these materials from databases including ovidMEDLINE and ovidEMBASE. Two reviewers independently screened materials on medical data recording, documentation and information processing and communication. Finally, all selected references were summarized, reconciled and compiled as one compatible document. Result Patients were dying and/or getting much suffering as the result of poor quality medical records. Electronic health record minimizes errors, saves unnecessary time, and money wasted on processing medical data. Conclusion Many countries have been complaining for incompleteness, inappropriateness and illegibility of records. Therefore creating awareness on the magnitude of the problem has paramount importance. Hence available correct patient information has lots of potential in reducing errors and support roles. PMID:24107106

Taiwan's perspective on electronic medical records' security and privacy protection: lessons learned from HIPAA.

PubMed

Yang, Che-Ming; Lin, Herng-Ching; Chang, Polun; Jian, Wen-Shan

2006-06-01

The protection of patients' health information is a very important concern in the information age. The purpose of this study is to ascertain what constitutes an effective legal framework in protecting both the security and privacy of health information, especially electronic medical records. All sorts of bills regarding electronic medical data protection have been proposed around the world including Health Insurance Portability and Accountability Act (HIPAA) of the U.S. The trend of a centralized bill that focuses on managing computerized health information is the part that needs our further attention. Under the sponsor of Taiwan's Department of Health (DOH), our expert panel drafted the "Medical Information Security and Privacy Protection Guidelines", which identifies nine principles and entails 12 articles, in the hope that medical organizations will have an effective reference in how to manage their medical information in a confidential and secured fashion especially in electronic transactions.

The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study.

PubMed

Garfield, Sara; Jheeta, Seetal; Husson, Fran; Lloyd, Jill; Taylor, Alex; Boucher, Charles; Jacklin, Ann; Bischler, Anna; Norton, Christine; Hayles, Rob; Franklin, Bryony Dean

2016-01-01

Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing. We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses' medication administration rounds, pharmacists' ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically. Paper or electronic medication records were shown to patients in only 4 (2%) of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture. Patients appear to have more access to paper-based records than electronic equivalents. However, to develop interventions to increase patient involvement with medication safety behaviours, a wider range of factors needs to be considered.

On standardization of basic datasets of electronic medical records in traditional Chinese medicine.

PubMed

Zhang, Hong; Ni, Wandong; Li, Jing; Jiang, Youlin; Liu, Kunjing; Ma, Zhaohui

2017-12-24

Standardization of electronic medical record, so as to enable resource-sharing and information exchange among medical institutions has become inevitable in view of the ever increasing medical information. The current research is an effort towards the standardization of basic dataset of electronic medical records in traditional Chinese medicine. In this work, an outpatient clinical information model and an inpatient clinical information model are created to adequately depict the diagnosis processes and treatment procedures of traditional Chinese medicine. To be backward compatible with the existing dataset standard created for western medicine, the new standard shall be a superset of the existing standard. Thus, the two models are checked against the existing standard in conjunction with 170,000 medical record cases. If a case cannot be covered by the existing standard due to the particularity of Chinese medicine, then either an existing data element is expanded with some Chinese medicine contents or a new data element is created. Some dataset subsets are also created to group and record Chinese medicine special diagnoses and treatments such as acupuncture. The outcome of this research is a proposal of standardized traditional Chinese medicine medical records datasets. The proposal has been verified successfully in three medical institutions with hundreds of thousands of medical records. A new dataset standard for traditional Chinese medicine is proposed in this paper. The proposed standard, covering traditional Chinese medicine as well as western medicine, is expected to be soon approved by the authority. A widespread adoption of this proposal will enable traditional Chinese medicine hospitals and institutions to easily exchange information and share resources. Copyright © 2017. Published by Elsevier B.V.

Using electronic clinical practice audits as needs assessment to produce effective continuing medical education programming.

PubMed

Klein, Doug; Staples, John; Pittman, Carmen; Stepanko, Cheryl

2012-01-01

The traditional needs assessment used in developing continuing medical education programs typically relies on surveying physicians and tends to only capture perceived learning needs. Instead, using tools available in electronic medical record systems to perform a clinical audit on a physician's practice highlights physician-specific practice patterns. The purpose of this study was to test the feasibility of implementing an electronic clinical audit needs assessment process for family physicians in Canada. A clinical audit of 10 preventative care interventions and 10 chronic disease interventions was performed on family physician practices in Alberta, Canada. The physicians used the results from the audit to produce personalized learning needs, which were then translated into educational programming. A total of 26 family practices and 4489 patient records were audited. Documented completion rates for interventions ranged from 13% for ensuring a patient's tetanus vaccine is current to 97% of pregnant patients receiving the recommended prenatal vitamins. Electronic medical record-based needs assessments may provide a better basis for developing continuing medical education than a more traditional survey-based needs assessment. This electronic needs assessment uses the physician's own patient outcome information to assist in determining learning objectives that reflect both perceived and unperceived needs.

Use of Electronic Health Records in sub-Saharan Africa: Progress and challenges

PubMed Central

Akanbi, Maxwell O.; Ocheke, Amaka N.; Agaba, Patricia A.; Daniyam, Comfort A.; Agaba, Emmanuel I.; Okeke, Edith N.; Ukoli, Christiana O.

2012-01-01

Background The Electronic Health Record (EHR) is a key component of medical informatics that is increasingly being utilized in industrialized nations to improve healthcare. There is limited information on the use of EHR in sub-Saharan Africa. This paper reviews availability of EHRs in sub-Saharan Africa. Methods Searches were performed on PubMed and Google Scholar databases using the terms ‘Electronic Health Records OR Electronic Medical Records OR e-Health and Africa’. References from identified publications were reviewed. Inclusion criterion was documented use of EHR in Africa. Results The search yielded 147 publications of which 21papers from 15 sub-Saharan African countries documented the use of EHR in Africa and were reviewed. About 91% reported use of Open Source healthcare software, with OpenMRS being the most widely used. Most reports were from HIV related health centers. Barriers to adoption of EHRs include high cost of procurement and maintenance, poor network infrastructure and lack of comfort among health workers with electronic medical records. Conclusion There has been an increase in the use of EHRs in sub-Saharan Africa, largely driven by utilization by HIV treatment programs. Penetration is still however very low. PMID:25243111

Enhanced identification of eligibility for depression research using an electronic medical record search engine.

PubMed

Seyfried, Lisa; Hanauer, David A; Nease, Donald; Albeiruti, Rashad; Kavanagh, Janet; Kales, Helen C

2009-12-01

Electronic medical records (EMRs) have become part of daily practice for many physicians. Attempts have been made to apply electronic search engine technology to speed EMR review. This was a prospective, observational study to compare the speed and clinical accuracy of a medical record search engine vs. manual review of the EMR. Three raters reviewed 49 cases in the EMR to screen for eligibility in a depression study using the electronic medical record search engine (EMERSE). One week later raters received a scrambled set of the same patients including 9 distractor cases, and used manual EMR review to determine eligibility. For both methods, accuracy was assessed for the original 49 cases by comparison with a gold standard rater. Use of EMERSE resulted in considerable time savings; chart reviews using EMERSE were significantly faster than traditional manual review (p=0.03). The percent agreement of raters with the gold standard (e.g. concurrent validity) using either EMERSE or manual review was not significantly different. Using a search engine optimized for finding clinical information in the free-text sections of the EMR can provide significant time savings while preserving clinical accuracy. The major power of this search engine is not from a more advanced and sophisticated search algorithm, but rather from a user interface designed explicitly to help users search the entire medical record in a way that protects health information.

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…

Electronic Medical Records (EMR): An Empirical Testing of Factors Contributing to Healthcare Professionals' Resistance to Use EMR Systems

ERIC Educational Resources Information Center

Bazile, Emmanuel Patrick

2016-01-01

The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to…

Strategies Nurse Managers Used to Offset Challenges during Electronic Medical Records Implementation: A Case Study

ERIC Educational Resources Information Center

Easterling, Latasha

2015-01-01

The purpose of this qualitative, descriptive case study was to discover successful approaches used, by nurse managers, to reduce barriers during the implementation of electronic medical record system in one hospital. Fourteen nurse managers were interviewed from an academic health science center in Mississippi. A pilot study was conducted to…

Telemedicine

MedlinePlus

... making health care delivery easier and more efficient. Electronic medical records are replacing paper charts. Digital devices ... 2016 More on this topic for: Parents Teens Electronic Health Records Talking to Your Child's Doctor How ...

Continuity of care through medical records--an explorative study on GPs' management considerations.

PubMed

Schers, Henk; van den Hoogen, Henk; Grol, Richard; van den Bosch, Wil

2006-06-01

The growing complexity of care with more professionals involved is a threat to the delivery of coherent and consistent care. Excellent exchange of information between professionals may be a way to maintain continuity of care. Relevant information to be passed over includes thoughts about future management for individual patients. To explore the nature of GPs' thoughts about future management, and to determine the extent to which such thoughts are actually recorded in medical records. Cross-sectional study of 5741 consultations. Thirty GPs from 17 practices in a region in the eastern part of The Netherlands. The GPs responded to an electronic questionnaire, directly after 200 successive consultations. The questionnaire included items on management considerations, consultation characteristics and personal continuity. We compared the data from the questionnaire to the actual recording of management considerations in the patient records. The GPs had management considerations in 66.4% of the consultations, involving mainly considerations about additional testing (15.5%), adjustment of medication (22.5%), alternative treatment plans (18.6%), possible referral (11.8%) and coping behaviour (18.0%). These considerations were seldom recorded in the electronic patient record; additional testing (3.0%) adjustment of medication (2.9%) and alternative treatment plans (4.1%). Surprisingly however, GPs rarely found that management considerations from earlier consultations were lacking in the medical record. GPs often have thoughts on how to deal with this patient, but hardly ever record such considerations. We recommend the development of tools that facilitate the recording of management considerations in electronic patient records.

The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance.

PubMed

Ahmed, Adil; Chandra, Subhash; Herasevich, Vitaly; Gajic, Ognjen; Pickering, Brian W

2011-07-01

The care of critically ill patients generates large quantities of data. Increasingly, these data are presented to the provider within an electronic medical record. The manner in which data are organized and presented can impact on the ability of users to synthesis that data into meaningful information. The objective of this study was to test the hypothesis that novel user interfaces, which prioritize the display of high-value data to providers within system-based packages, reduce task load, and result in fewer errors of cognition compared with established user interfaces that do not. Randomized crossover study. Academic tertiary referral center. Attending, resident and fellow critical care physicians. Novel health care record user interface. Subjects randomly assigned to either a standard electronic medical record or a novel user interface, were asked to perform a structured task. The task required the subjects to use the assigned electronic environment to review the medical record of an intensive care unit patient said to be actively bleeding for data that formed the basis of answers to clinical questions posed in the form of a structured questionnaire. The primary outcome was task load, measured using the paper version of the NASA-task load index. Secondary outcome measures included time to task completion, number of errors of cognition measured by comparison of subject to post hoc gold standard questionnaire responses, and the quantity of information presented to subjects by each environment. Twenty subjects completed the task on eight patients, resulting in 160 patient-provider encounters (80 in each group). The standard electronic medical record contained a much larger data volume with a median (interquartile range) number of data points per patient of 1008 (895-1183) compared with 102 (77-112) contained within the novel user interface. The median (interquartile range) NASA-task load index values were 38.8 (32-45) and 58 (45-65) for the novel user interface compared with the standard electronic medical record (p < .001). The median (interquartile range) times in seconds taken to complete the task for four consecutive patients were 93 (57-132), 60 (48-71), 68 (48-80), and 54 (42-64) for the novel user interface compared with 145 (109-201), 125 (113-162), 129 (100-145), and 112 (92-123) for the standard interface (p < .0001), respectively. The median (interquartile range) number of errors per provider was 0.5 (0-1) and two (0.25-3) for the novel user interface and standard electronic medical record interface, respectively (p = .007). A novel user interface was designed based on the information needs of intensive care unit providers with a specific goal of development being the reduction of task load and errors of cognition associated with filtering, extracting, and using medical data contained within a comprehensive electronic medical record. The results of this simulated clinical experiment suggest that the configuration of the intensive care unit user interface contributes significantly to the task load, time to task completion, and number of errors of cognition associated with the identification, and subsequent use, of relevant patient data. Task-specific user interfaces, developed from an understanding of provider information requirements, offer advantages over interfaces currently available within a standard electronic medical record.

Protecting clinical data in PACS, teleradiology systems, and research environments

NASA Astrophysics Data System (ADS)

Meissner, Marion C.; Collmann, Jeff R.; Tohme, Walid G.; Mun, Seong K.

1997-05-01

As clinical data is more widely stored in electronic patient record management systems and transmitted over the Internet and telephone lines, it becomes more accessible and therefore more useful, but also more vulnerable. Computer systems such as PACS, telemedicine applications, and medical research networks must protect against accidental or deliberate modification, disclosure, and violation of patient confidentiality in order to be viable. Conventional wisdom in the medical field and among lawmakers legislating the use of electronic medical records suggests that, although it may improve access to information, an electronic medical record cannot be as secure as a traditional paper record. This is not the case. Information security is a well-developed field in the computer and communications industry. If medical information systems, such as PACS, telemedicine applications, and research networks, properly apply information security techniques, they can ensure the accuracy and confidentiality of their patient information and even improve the security of their data over a traditional paper record. This paper will elaborate on some of these techniques and discuss how they can be applied to medical information systems. The following systems will be used as examples for the analysis: a research laboratory at Georgetown University Medical Center, the Deployable Radiology system installed to support the US Army's peace- keeping operation in Bosnia, a kidney dialysis telemedicine system in Washington, D.C., and various experiences with implementing and integrating PACS.

National electronic medical records integration on cloud computing system.

PubMed

Mirza, Hebah; El-Masri, Samir

2013-01-01

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

Discrepancies in medication entries between anesthetic and pharmacy records using electronic databases.

PubMed

Vigoda, Michael M; Gencorelli, Frank J; Lubarsky, David A

2007-10-01

Accurate recording of disposition of controlled substances is required by regulatory agencies. Linking anesthesia information management systems (AIMS) with medication dispensing systems may facilitate automated reconciliation of medication discrepancies. In this retrospective investigation at a large academic hospital, we reviewed 11,603 cases (spanning an 8-mo period) comparing records of medications (i.e., narcotics, benzodiazepines, ketamine, and thiopental) recorded as removed from our automated medication dispensing system with medications recorded as administered in our AIMS. In 15% of cases, we found discrepancies between dispensed versus administered medications. Discrepancies occurred in both the AIMS (8% cases) and the medication dispensing system (10% cases). Although there were many different types of user errors, nearly 75% of them resulted from either an error in the amount of drug waste documented in the medication dispensing system (35%); or an error in documenting the medication in the AIMS (40%). A significant percentage of cases contained data entry errors in both the automated dispensing and AIMS. This error rate limits the current practicality of automating the necessary reconciliation. An electronic interface between an AIMS and a medication dispensing system could alert users of medication entry errors prior to finalizing a case, thus reducing the time (and cost) of reconciling discrepancies.

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

PubMed

Bouamrane, Matt-Mouley; Mair, Frances S

2013-05-21

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

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

PubMed Central

2013-01-01

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

The Transition from Paper to Digital: Lessons for Medical Specialty Societies

PubMed Central

Miller, Donald W.

2008-01-01

Medical specialty societies often serve their membership by publishing paper forms that may simultaneously include practice guidelines, dataset specifications, and suggested layouts. Many times these forms become de facto standards for the specialty but transform poorly to the logic, structure, preciseness, and flexibility needed in modern electronic medical records. This paper analyzes one such form - a prenatal record published by the American College of Obstetricians and Gynecologists - with the intent to elucidate lessons for other specialty societies who might craft their recommendations to be effectively incorporated within modern electronic medical records. Lessons learned include separating datasets from guidelines/recommendations, specifying, codifying, and qualifying atomic data elements, and leaving graphic design to professionals. PMID:18998856

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

PubMed Central

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

2005-01-01

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

Computing disease incidence, prevalence and comorbidity from electronic medical records.

PubMed

Bagley, Steven C; Altman, Russ B

2016-10-01

Electronic medical records (EMR) represent a convenient source of coded medical data, but disease patterns found in EMRs may be biased when compared to surveys based on sampling. In this communication we draw attention to complications that arise when using EMR data to calculate disease prevalence, incidence, age of onset, and disease comorbidity. We review known solutions to these problems and identify challenges for future work. Copyright © 2016 Elsevier Inc. All rights reserved.

Invite yourself to the table: librarian contributions to the electronic medical record.

PubMed

Brandes, Susan; Wells, Karen; Bandy, Margaret

2013-01-01

Librarians from Exempla Healthcare hospitals initiated contact with the chief medical information officer regarding evidence-based medicine activities related to the development of the system's Electronic Medical Record (EMR). This column reviews the librarians' involvement in specific initiatives that included providing comparative information on point-of-care resources to integrate into the EMR, providing evidence as needed for the order sets being developed, and participating with clinicians on an evidence-based advisory committee.

Semantic-Web Architecture for Electronic Discharge Summary Based on OWL 2.0 Standard.

PubMed

Tahmasebian, Shahram; Langarizadeh, Mostafa; Ghazisaeidi, Marjan; Safdari, Reza

2016-06-01

Patients' electronic medical record contains all information related to treatment processes during hospitalization. One of the most important documents in this record is the record summary. In this document, summary of the whole treatment process is presented which is used for subsequent treatments and other issues pertaining to the treatment. Using suitable architecture for this document, apart from the aforementioned points we can use it in other fields such as data mining or decision making based on the cases. In this study, at first, a model for patient's medical record summary has been suggested using semantic web-based architecture. Then, based on service-oriented architecture and using Java programming language, a software solution was designed and run in a way to generate medical record summary with this structure and at the end, new uses of this structure was explained. in this study a structure for medical record summaries along with corrective points within semantic web has been offered and a software running within Java along with special ontologies are provided. After discussing the project with the experts of medical/health data management and medical informatics as well as clinical experts, it became clear that suggested design for medical record summary apart from covering many issues currently faced in the medical records has also many advantages including its uses in research projects, decision making based on the cases etc.

[The development and operation of a package inserts service system for electronic medical records].

PubMed

Yamada, Hidetoshi; Nishimura, Sachiho; Shimamori, Yoshimitsu; Sato, Seiji; Hayase, Yukitoshi

2003-03-01

To promote the appropriate use of pharmaceuticals and to prevent side effects, physicians need package inserts on medicinal drugs as soon as possible. A medicinal drug information service system was established for electronic medical records to speed up and increase the efficiency of package insert communications within a medical institution. Development of this system facilitates access to package inserts by, for example, physicians. The time required to maintain files of package inserts was shortened, and the efficiency of the drug information service increased. As a source of package inserts for this system, package inserts using a standard generalized markup language (SGML) form were used, which are accessible to the public on the homepage of the Organization for Pharmaceutical Safety and Research (OPSR). This study found that a delay occurred in communicating revised package inserts from pharmaceutical companies to the OPSR. Therefore a pharmaceutical department page was set up as part of the homepage of the medical institution for electronic medical records to shorten the delay in the revision of package inserts posted on the medicinal drug information service homepage of the OPSR. The usefulness of this package insert service system for electronic medical records is clear. For more effective use of this system based on the OPSR homepage pharmaceutical companies have been requested to provide quicker updating of package inserts.

Usability of a mobile electronic medical record prototype: a verbal protocol analysis.

PubMed

Wu, Robert C; Orr, M Scott; Chignell, Mark; Straus, Sharon E

2008-06-01

Point of care access to electronic medical records may provide clinicians with the information they want when they need it and may in turn improve patient safety. Yet providing an electronic medical record on handheld devices presents many usability challenges, and it is unclear whether clinicians will use them. An iterative design process for the development and evaluation of a prototype of a mobile electronic medical record was performed. Usability sessions were conducted in which physicians were asked to 'think aloud' while working through clinical scenarios using the prototype. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts from the sessions and common themes were extracted. Usability sessions were held with five family physicians and four internists with varying levels of computer expertise. Physicians were able to use the device to complete 52 of 54 required tasks. Users commented that it was intuitive (9/9), would increase accessibility (5/9) but for them to use it, it would need the system to be fast and time-saving (5/9). Users had difficulty entering information (5/9) and reading the screen (4/9). In terms of functionality, users had concerns about completeness of information (6/9), details of ordering (5/9) and desired billing functionality (5/9) and integration with other systems (4/9). While physicians can use mobile electronic medical records in realistic scenarios, certain requirements likely need to be met including a fast system with easy data selection, easy data entry and improved display before widespread adoption occurs.

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

PubMed Central

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

2013-01-01

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

Use of Patient-Authored Prehistory to Improve Patient Experiences and Accommodate Federal Law.

PubMed

Warner, Michael J; Simunich, Thomas J; Warner, Margaret K; Dado, Joseph

2017-02-01

Although federal law grants patients the right to view and amend their medical records, few studies have proposed a process for patients to coauthor their subjective history in their medical record. Allowing patients to fully disclose and document their medical history is an important step to improve the diagnostic process. To evaluate patients' office experience before and after they authored their subjective medical history for the electronic health record. Patients were mailed a prehistory form and presurvey to be completed before their family medicine office visit. On arrival to the office, the prehistory form was scanned into the electronic health record while the content was transcribed by hospital staff into the appropriate fields in the history component of the encounter note. Postsurveys were given to patients to be completed after their visit. Pre- and postsurveys measured the patients' perception of office visit quality as well as completeness and accuracy of their electronic health record documentation before and after their appointment. Medical staff surveys were collected weekly to measure the staff's viewpoint of the federal law that allows patients to view and amend their medical records. Of 405 patients who were asked to participate, 263 patients aged 14 to 94 years completed a presurvey and a prehistory form. Of those 263 patients, 134 completed a postsurvey. The pre- and postsurveys showed improved patient satisfaction with the office visit and high scores for documentation accuracy and completeness. Before filling out the prehistory form, 116 of 249 patients (46.6%) agreed or strongly agreed that they felt more empowered in their health care by completing the prehistory form compared with 110 of 131 (84.0%) who agreed or strongly agreed after the visit (P<.001). Staff members agreed that patients should have the right to view and amend their medical records in accordance with federal law. Empowering patients to contribute subjective information to their electronic health record has the potential to improve the diagnostic process. When conducting a medical encounter, the authors recommend having patients complete a prehistory form beforehand to improve the patient experience while accommodating federal law.

Examining the Role of Electronic Medical Record Generated Provider Reminders on Provider Offering of Breast Cancer Screening Services

ERIC Educational Resources Information Center

Beverley, Charles St. Clare, Jr.

2013-01-01

Introduction: Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for…

Organizational Change and How It Affects Healthcare Employees: A Study on Employee Resistance to Change in Electronic Medical Record Implementation

ERIC Educational Resources Information Center

Adeyemi, Oluwakemi A.

2017-01-01

The purpose of the exploratory qualitative study was to explore the strategies for reducing employee resistance to Electronic Medical Record (EMR) technology changes in a healthcare organization during implementation. The study focused on EPIC as the EMR application. Ten healthcare participants who had experienced a change to EMR were selected in…

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

ERIC Educational Resources Information Center

Thompson, Chester D.

2013-01-01

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

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…

Openness of patients' reporting with use of electronic records: psychiatric clinicians' views

PubMed Central

Blackford, Jennifer Urbano; Rosenbloom, S Trent; Seidel, Sandra; Clayton, Ellen Wright; Dilts, David M; Finder, Stuart G

2010-01-01

Objectives Improvements in electronic health record (EHR) system development will require an understanding of psychiatric clinicians' views on EHR system acceptability, including effects on psychotherapy communications, data-recording behaviors, data accessibility versus security and privacy, data quality and clarity, communications with medical colleagues, and stigma. Design Multidisciplinary development of a survey instrument targeting psychiatric clinicians who recently switched to EHR system use, focus group testing, data analysis, and data reliability testing. Measurements Survey of 120 university-based, outpatient mental health clinicians, with 56 (47%) responding, conducted 18 months after transition from a paper to an EHR system. Results Factor analysis gave nine item groupings that overlapped strongly with five a priori domains. Respondents both praised and criticized the EHR system. A strong majority (81%) felt that open therapeutic communications were preserved. Regarding data quality, content, and privacy, clinicians (63%) were less willing to record highly confidential information and disagreed (83%) with including their own psychiatric records among routinely accessed EHR systems. Limitations single time point; single academic medical center clinic setting; modest sample size; lack of prior instrument validation; survey conducted in 2005. Conclusions In an academic medical center clinic, the presence of electronic records was not seen as a dramatic impediment to therapeutic communications. Concerns regarding privacy and data security were significant, and may contribute to reluctances to adopt electronic records in other settings. Further study of clinicians' views and use patterns may be helpful in guiding development and deployment of electronic records systems. PMID:20064802

A Leader in Clinical Trials, Medical Data, & Electronic Health Information | NIH MedlinePlus the Magazine

MedlinePlus

... Bachrach A Leader in Clinical Trials, Medical Data, & Electronic Health Information This year marks the175th anniversary of ... PHR) The Lister Hill Center researches next-generation electronic health records to facilitate individualized patient care and ...

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

PubMed Central

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

2004-01-01

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

Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record.

PubMed

Opondo, Dedan; Visscher, Stefan; Eslami, Saeid; Verheij, Robert A; Korevaar, Joke C; Abu-Hanna, Ameen

2015-01-01

To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. We included patients 65 years and older who received NSAIDs between 2005 and 2010. Prescription data were extracted from EMR systems of GP practices participating in the Dutch NIVEL Primary Care Database. We calculated the proportion of NSAID prescriptions with co-prescription of gastroprotective medication for each GP practice at intervals of three months. Association between proportion of gastroprotection, brand of electronic medical record (EMR), and type of GP practice were explored. Temporal trends in proportion of gastroprotection between electronic medical records systems were analyzed using a random effects linear regression model. We included 91,521 patient visits with NSAID prescriptions from 77 general practices between 2005 and 2010. Overall proportion of NSAID prescriptions to the elderly with co-prescription of gastroprotective medication was 43%. Mean proportion of gastroprotection increased from 27% (CI 25-29%) in the first quarter of 2005 with a rate of 1.2% every 3 months to 55%(CI 52-58%) at the end of 2010. Brand of EMR and type of GP practice were independently associated with co-prescription of gastroprotection. Although prescription of gastroprotective medications to elderly patients who receive NSAIDs increased in The Netherlands, they are not co-prescribed in about half of the indicated cases. Brand of EMR system is associated with differences in prescription of gastroprotective medication. Optimal design and utilization of EMRs is a potential area of intervention to improve quality of prescription.

Applicability of different types of Patient Records for Patient Recruitment Systems.

PubMed

Schreiweis, Björn; Bergh, Björn

2015-01-01

Patient records--types of Electronic Medical Records--are implemented to support patient recruitment. Different types of patient records have not yet been analyzed as to the number of Patient Recruitment System requirements can be found in each type of patient record. According to our analysis, personal electronic health records (PEHRs) tend to allow for most requirements to be found.

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

PubMed

Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

2015-06-01

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

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

PubMed

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

2002-01-01

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

Confidentiality Protection of Digital Health Records in Cloud Computing.

PubMed

Chen, Shyh-Wei; Chiang, Dai Lun; Liu, Chia-Hui; Chen, Tzer-Shyong; Lai, Feipei; Wang, Huihui; Wei, Wei

2016-05-01

Electronic medical records containing confidential information were uploaded to the cloud. The cloud allows medical crews to access and manage the data and integration of medical records easily. This data system provides relevant information to medical personnel and facilitates and improve electronic medical record management and data transmission. A structure of cloud-based and patient-centered personal health record (PHR) is proposed in this study. This technique helps patients to manage their health information, such as appointment date with doctor, health reports, and a completed understanding of their own health conditions. It will create patients a positive attitudes to maintain the health. The patients make decision on their own for those whom has access to their records over a specific span of time specified by the patients. Storing data in the cloud environment can reduce costs and enhance the share of information, but the potential threat of information security should be taken into consideration. This study is proposing the cloud-based secure transmission mechanism is suitable for multiple users (like nurse aides, patients, and family members).

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report.

PubMed

Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

2004-10-16

Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report

PubMed Central

Lærum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

2004-01-01

Background Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. Methods We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. Results The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Conclusions Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS. PMID:15488150

Developing an Interface to Order and Document Health Education Videos in the Electronic Health Record.

PubMed

Wojcik, Lauren

2015-01-01

Transitioning to electronic health records (EHRs) provides an opportunity for health care systems to integrate educational content available on interactive patient systems (IPS) with the medical documentation system. This column discusses how one hospital simplified providers' workflow by making it easier to order educational videos and ensure that completed education is documented within the medical record. Integrating the EHR and IPS streamlined the provision of patient education, improved documentation, and supported the organization in meeting core requirements for Meaningful Use.

Framing Electronic Medical Records as Polylingual Documents in Query Expansion

PubMed Central

Huang, Edward W; Wang, Sheng; Lee, Doris Jung-Lin; Zhang, Runshun; Liu, Baoyan; Zhou, Xuezhong; Zhai, ChengXiang

2017-01-01

We present a study of electronic medical record (EMR) retrieval that emulates situations in which a doctor treats a new patient. Given a query consisting of a new patient’s symptoms, the retrieval system returns the set of most relevant records of previously treated patients. However, due to semantic, functional, and treatment synonyms in medical terminology, queries are often incomplete and thus require enhancement. In this paper, we present a topic model that frames symptoms and treatments as separate languages. Our experimental results show that this method improves retrieval performance over several baselines with statistical significance. These baselines include methods used in prior studies as well as state-of-the-art embedding techniques. Finally, we show that our proposed topic model discovers all three types of synonyms to improve medical record retrieval. PMID:29854161

Electronic Health Records

MedlinePlus

... Doctors and hospitals are turning to new health information technology, and while these changes won't happen overnight, they are coming. Understanding EHRs Electronic health records (EHR) — ... information like your age, gender, ethnicity, health history, medications, ...

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

PubMed

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

2012-08-01

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

The Use of the Academic Electronic Medical Record (EMR) to Develop Critical Thinking Skills in an Associate Degree Nursing Mobility Program

ERIC Educational Resources Information Center

Wlodyga, Linda J.

2010-01-01

In an attempt to prepare new graduate nurses to meet the demands of health care delivery systems, the use of computer-based clinical information systems that combine hands-on experience with computer based information systems was explored. Since the introduction of Electronic Medical Records (EMR) nearly two decades ago, the demand for nurses to…

A Qualitative Study to Evaluate the Effectiveness of Simulation as a Training Method in Implementation of Electronic Medical Records

ERIC Educational Resources Information Center

Chelton, Barbara S.

2009-01-01

Background: Adoption of electronic medical records has been gradual in part due to physician concerns that its use in the exam room will interfere with the physician-patient relationship. Studies demonstrate their concern to be loss of eye contact with the patient and that entering information into the computer in the presence of the patient will…

Understanding Productivity and Technostress for Oncology Nurses Using an Electronic Health Record (EHR) to Increase Safety, Quality, and Effectiveness of Care for Patients with Cancer

ERIC Educational Resources Information Center

Evans, Elizabeth M. Wertz

2013-01-01

Health information technology has become more prevalent in hospitals, physician offices, clinics, and other areas of medical treatment, especially since the federal government passed legislation to offer incentive payments for the meaningful use of electronic health records (EHRs). Previous research demonstrated a decrease in medical errors as…

Integrating traditional nursing service orientation content with electronic medical record orientation.

PubMed

Harton, Brenda B; Borrelli, Larry; Knupp, Ann; Rogers, Necolen; West, Vickie R

2009-01-01

Traditional nursing service orientation classes at an acute care hospital were integrated with orientation to the electronic medical record to blend the two components in a user-friendly format so that the learner is introduced to the culture, processes, and documentation methods of the organization, with an opportunity to document online in a practice domain while lecture and discussion information is fresh.

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…

Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?

PubMed

Lowe, Jeanne R; Raugi, Gregory J; Reiber, Gayle E; Whitney, Joanne D

2013-01-01

The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention. From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding. The intervention group showed significant differences in complete documentation of good wound care compared to the historic control group (χ = 15.99, P < .001), complete documentation of coding for diagnoses and procedures (χ = 30.23, P < .001), and complete documentation of both good wound care and coding for diagnoses and procedures (χ = 14.96, P < .001). An electronic wound care template improved documentation of evidence-based interventions and facilitated coding for wound complexity and procedures.

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. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

The Patient Portal of the Personal Cross-Enterprise Electronic Health Record (PEHR) in the Rhine-Neckar-Region.

PubMed

Brandner, Antje; Schreiweis, Björn; Aguduri, Lakshmi S; Bronsch, Tobias; Kunz, Aline; Pensold, Peter; Stein, Katharina E; Weiss, Nicolas; Yüksekogul, Nilay; Bergh, Björn; Heinze, Oliver

2016-01-01

Over the last years we stepwise implemented our vision of a personal cross-enterprise electronic health record (PEHR) in the Rhine-Neckar-Region in Germany. The patient portal is one part of the PEHR architecture with IHE connectivity. The patient is enabled to access and manage his medical record by use of the patient portal. Moreover, he can give his consent regarding which healthcare providers are allowed to send data into or read data from his medical record. Forthcoming studies will give evidence for improvements and further requirements to develop.

Using Electronic Medical Records to Assess the Effectiveness of Pharmacotherapy in Pain: A Review of Recent Observational Studies.

PubMed

Biltaji, Eman; Tak, Casey; Ma, Junjie; Ruiz-Negron, Natalia; Bellows, Brandon K

2016-09-01

Pain disorders affect a large number of individuals throughout the world and are costly. Although randomized clinical trials assess the efficacy (i.e., how well treatments work in controlled settings) of pain pharmacotherapy, clinical trials do not assess effectiveness (i.e., how well treatments work in real-world settings). The number of observational studies that use real-world data to assess the effectiveness of medications is increasing rapidly in many disease areas. It is important for clinicians to understand how real-world data may be used to assess the effectiveness of medications. This paper aims to review the current body of literature assessing the effectiveness of pain pharmacotherapy using medical records. To do this, a literature search was conducted to identify papers published between January 2013 and September 2015 that examined the effectiveness of pain pharmacotherapy using electronic medical records. The search found only three papers meeting these criteria, which were described, reviewed, and critiqued in this paper. Electronic medical records are an underutilized source of data to assess pain outcomes in real-world settings. Although there are many methodological challenges in using these data, there is also great opportunity to impact clinical practice and explore the real-world effectiveness of pharmacotherapy used in pain management.

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

PubMed

Caine, Kelly; Hanania, Rima

2013-01-01

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

The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study

PubMed Central

Garfield, Sara; Jheeta, Seetal; Husson, Fran; Lloyd, Jill; Taylor, Alex; Boucher, Charles; Jacklin, Ann; Bischler, Anna; Norton, Christine; Hayles, Rob; Dean Franklin, Bryony

2016-01-01

Background Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients’ involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing. Methods We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses’ medication administration rounds, pharmacists’ ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically. Results Paper or electronic medication records were shown to patients in only 4 (2%) of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture. Conclusion Patients appear to have more access to paper-based records than electronic equivalents. However, to develop interventions to increase patient involvement with medication safety behaviours, a wider range of factors needs to be considered. PMID:27093438

Real-time Automated Sampling of Electronic Medical Records Predicts Hospital Mortality

PubMed Central

Khurana, Hargobind S.; Groves, Robert H.; Simons, Michael P.; Martin, Mary; Stoffer, Brenda; Kou, Sherri; Gerkin, Richard; Reiman, Eric; Parthasarathy, Sairam

2016-01-01

Background Real-time automated continuous sampling of electronic medical record data may expeditiously identify patients at risk for death and enable prompt life-saving interventions. We hypothesized that a real-time electronic medical record-based alert could identify hospitalized patients at risk for mortality. Methods An automated alert was developed and implemented to continuously sample electronic medical record data and trigger when at least two of four systemic inflammatory response syndrome criteria plus at least one of 14 acute organ dysfunction parameters was detected. The SIRS/OD alert was applied real-time to 312,214 patients in 24 hospitals and analyzed in two phases: training and validation datasets. Results In the training phase, 29,317 (18.8%) triggered the alert and 5.2% of such patients died whereas only 0.2% without the alert died (unadjusted odds ratio 30.1; 95% confidence interval [95%CI] 26.1, 34.5; P<0.0001). In the validation phase, the sensitivity, specificity, area under curve (AUC), positive and negative likelihood ratios for predicting mortality were 0.86, 0.82, 0.84, 4.9, and 0.16, respectively. Multivariate Cox-proportional hazard regression model revealed greater hospital mortality when the alert was triggered (adjusted Hazards Ratio 4.0; 95%CI 3.3, 4.9; P<0.0001). Triggering the alert was associated with additional hospitalization days (+3.0 days) and ventilator days (+1.6 days; P<0.0001). Conclusion An automated alert system that continuously samples electronic medical record-data can be implemented, has excellent test characteristics, and can assist in the real-time identification of hospitalized patients at risk for death. PMID:27019043

Online personal medical records: are they reliable for acute/critical care?

PubMed

Schneider, J H

2001-08-01

To provide an introduction to Internet-based Online Personal Medical Records (OPMRs), to assess their use and limitations in acute/critical care situations, and to identify potential improvements that could increase their usefulness. A review of publicly available Internet-based OPMRs conducted in April 2001. Twenty-nine OPMR sites were identified in March 2000 using ten Internet search engines with the search term "Personal Medical Records." Through 2000 and 2001, an additional 37 sites were identified using lists obtained from trade journals and through the author's participation in standards-setting meetings. Each publicly available site was reviewed to assess suitability for acute/critical care situations using four measures developed by the author and for general use using eight measures developed in a standards-setting process described in the article. Of the 66 companies identified, only 16 still offer OPMRs that are available to the public on the Internet. None of these met all of the evaluation measures. Only 19% had rapid emergency access capabilities and only 63% provided medical summaries of the record. Security and confidentiality issues were well addressed in 94% of sites. Data portability was virtually nonexistent because all OPMRs lacked the ability to exchange data electronically with other OPMRs, and only two OPMRs permitted data transfer from physician electronic medical records. Controls over data accuracy were poor: 81% of sites allowed entry of dates for medical treatment before the patient's date of birth, and one site actually gave incorrect medical advice. OPMRs were periodically inaccessible because of programming deficiencies. Finally, approximately 40 sites ceased providing OPMRs in the past year, with the probable loss of patient information. Most OPMRs are not ready for use in acute/critical care situations. Many are just electronic versions of the paper-based health record notebooks that patients have used for years. They have, however, great promise and, with further development, could form the basis of a new medical record system that could contribute to improving the quality of medical care.

Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases.

PubMed

Raebel, Marsha A; Schmittdiel, Julie; Karter, Andrew J; Konieczny, Jennifer L; Steiner, John F

2013-08-01

To propose a unifying set of definitions for prescription adherence research utilizing electronic health record prescribing databases, prescription dispensing databases, and pharmacy claims databases and to provide a conceptual framework to operationalize these definitions consistently across studies. We reviewed recent literature to identify definitions in electronic database studies of prescription-filling patterns for chronic oral medications. We then develop a conceptual model and propose standardized terminology and definitions to describe prescription-filling behavior from electronic databases. The conceptual model we propose defines 2 separate constructs: medication adherence and persistence. We define primary and secondary adherence as distinct subtypes of adherence. Metrics for estimating secondary adherence are discussed and critiqued, including a newer metric (New Prescription Medication Gap measure) that enables estimation of both primary and secondary adherence. Terminology currently used in prescription adherence research employing electronic databases lacks consistency. We propose a clear, consistent, broadly applicable conceptual model and terminology for such studies. The model and definitions facilitate research utilizing electronic medication prescribing, dispensing, and/or claims databases and encompasses the entire continuum of prescription-filling behavior. Employing conceptually clear and consistent terminology to define medication adherence and persistence will facilitate future comparative effectiveness research and meta-analytic studies that utilize electronic prescription and dispensing records.

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

PubMed Central

Chan, Lenny L. S.; Fouts, Michelle M.; Murphy, Elizabeth J.

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations. PMID:28197420

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations.

PubMed

Ratanawongsa, Neda; Chan, Lenny L S; Fouts, Michelle M; Murphy, Elizabeth J

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

A Medical Decision Support System for the Space Station Health Maintenance Facility

PubMed Central

Ostler, David V.; Gardner, Reed M.; Logan, James S.

1988-01-01

NASA is developing a Health Maintenance Facility (HMF) to provide the equipment and supplies necessary to deliver medical care in the Space Station. An essential part of the Health Maintenance Facility is a computerized Medical Decision Support System (MDSS) that will enhance the ability of the medical officer (“paramedic” or “physician”) to maintain the crew's health, and to provide emergency medical care. The computer system has four major functions: 1) collect and integrate medical information into an electronic medical record from Space Station medical officers, HMF instrumentation, and exercise equipment; 2) provide an integrated medical record and medical reference information management system; 3) manage inventory for logistical support of supplies and secure pharmaceuticals; 4) supply audio and electronic mail communications between the medical officer and ground based flight surgeons. ImagesFigure 1

Evaluating a Serious Gaming Electronic Medication Administration Record System Among Nursing Students: Protocol for a Pragmatic Randomized Controlled Trial.

PubMed

Booth, Richard; Sinclair, Barbara; McMurray, Josephine; Strudwick, Gillian; Watson, Gavan; Ladak, Hanif; Zwarenstein, Merrick; McBride, Susan; Chan, Ryan; Brennan, Laura

2018-05-28

Although electronic medication administration record systems have been implemented in settings where nurses work, nursing students commonly lack robust learning opportunities to practice the skills and workflow of digitalized medication administration during their formative education. As a result, nursing students' performance in administering medication facilitated by technology is often poor. Serious gaming has been recommended as a possible intervention to improve nursing students' performance with electronic medication administration in nursing education. The objectives of this study are to examine whether the use of a gamified electronic medication administration simulator (1) improves nursing students' attention to medication administration safety within simulated practice, (2) increases student self-efficacy and knowledge of the medication administration process, and (3) improves motivational and cognitive processing attributes related to student learning in a technology-enabled environment. This study comprised the development of a gamified electronic medication administration record simulator and its evaluation in 2 phases. Phase 1 consists of a prospective, pragmatic randomized controlled trial with second-year baccalaureate nursing students at a Canadian university. Phase 2 consists of qualitative focus group interviews with a cross-section of nursing student participants. The gamified medication administration simulator has been developed, and data collection is currently under way. If the gamified electronic medication administration simulator is found to be effective, it could be used to support other health professional simulated education and scaled more widely in nursing education programs. ClinicalTrials.gov NCT03219151; https://clinicaltrials.gov/show/NCT03219151 (Archived by WebCite at http://www.webcitation.org/6yjBROoDt). RR1-10.2196/9601. ©Richard Booth, Barbara Sinclair, Josephine McMurray, Gillian Strudwick, Gavan Watson, Hanif Ladak, Merrick Zwarenstein, Susan McBride, Ryan Chan, Laura Brennan. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 28.05.2018.

Guide to the NITRD Program FY 2004-FY 2005. Supplement to the President’s Budget for FY 2005

DTIC Science & Technology

2004-12-01

electronic medical records systems . At the core of such systems is the concept of a secure, patient-centered electronic health record ( EHR ) that: 1...support the development of an NHII that includes an Electronic Health Record System ( EHRS ). The EHRS will be a longitudinal collection of electronic... health information for and about persons. It will allow electronic access to person- and population-level information by authorized users. The system

A pilot study to evaluate the magnitude of association of the use of electronic personal health records with patient activation and empowerment in HIV-infected veterans

PubMed Central

Rose, Carol Dawson; Johnson, Mallory; Janson, Susan L.

2015-01-01

The HITECH Act signed into law in 2009 requires hospitals to provide patients with electronic access to their health information through an electronic personal health record (ePHR) in order to receive Medicare/Medicaid incentive payments. Little is known about who uses these systems or the impact these systems will have on patient outcomes in HIV care. The health care empowerment model provides rationale for the hypothesis that knowledge from an electronic personal health record can lead to greater patient empowerment resulting in improved outcomes. The objective was to determine the patient characteristics and patient activation, empowerment, satisfaction, knowledge of their CD4, Viral Loads, and antiretroviral medication, and medication adherence outcomes associated with electronic personal health record use in Veterans living with HIV at the San Francisco VA Medical Center. The participants included HIV-Infected Veterans receiving care in a low volume HIV-clinic at the San Francisco VA Medical Center, divided into two groups of users and non-users of electronic personal health records. The research was conducted using in-person surveys either online or on paper and data abstraction from medical records for current anti-retroviral therapy (ART), CD4 count, and plasma HIV-1 viral load. The measures included the Patient Activation Measure, Health Care Empowerment Inventory, ART adherence, provider satisfaction, current CD4 count, current plasma viral load, knowledge of current ART, knowledge of CD4 counts, and knowledge of viral load. In all, 40 participants were recruited. The use of electronic personal health records was associated with significantly higher levels of patient activation and levels of patient satisfaction for getting timely appointments, care, and information. ePHR was also associated with greater proportions of undetectable plasma HIV-1 viral loads, of knowledge of current CD4 count, and of knowledge of current viral load. The two groups differed by race and computer access. There was no difference in the current CD4, provider satisfaction, Health Care Empowerment Inventory score, satisfaction with provider-patient communication, satisfaction with courteous and helpful staff, knowledge of ART, or ART adherence. The use of electronic personal health records is associated with positive clinical and behavioral characteristics. The use of these systems may play a role in improving the health of people with HIV. Larger studies are needed to further evaluate these associations. PMID:25802815

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs.

PubMed

McCoy, A B; Wright, A; Krousel-Wood, M; Thomas, E J; McCoy, J A; Sittig, D F

2015-01-01

Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs

PubMed Central

Wright, A.; Krousel-Wood, M.; Thomas, E. J.; McCoy, J. A.; Sittig, D. F.

2015-01-01

Summary Background Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. Objective We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. Methods We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. Results The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. Conclusions We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes. PMID:26171079

Supporting information retrieval from electronic health records: A report of University of Michigan's nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE).

PubMed

Hanauer, David A; Mei, Qiaozhu; Law, James; Khanna, Ritu; Zheng, Kai

2015-06-01

This paper describes the University of Michigan's nine-year experience in developing and using a full-text search engine designed to facilitate information retrieval (IR) from narrative documents stored in electronic health records (EHRs). The system, called the Electronic Medical Record Search Engine (EMERSE), functions similar to Google but is equipped with special functionalities for handling challenges unique to retrieving information from medical text. Key features that distinguish EMERSE from general-purpose search engines are discussed, with an emphasis on functions crucial to (1) improving medical IR performance and (2) assuring search quality and results consistency regardless of users' medical background, stage of training, or level of technical expertise. Since its initial deployment, EMERSE has been enthusiastically embraced by clinicians, administrators, and clinical and translational researchers. To date, the system has been used in supporting more than 750 research projects yielding 80 peer-reviewed publications. In several evaluation studies, EMERSE demonstrated very high levels of sensitivity and specificity in addition to greatly improved chart review efficiency. Increased availability of electronic data in healthcare does not automatically warrant increased availability of information. The success of EMERSE at our institution illustrates that free-text EHR search engines can be a valuable tool to help practitioners and researchers retrieve information from EHRs more effectively and efficiently, enabling critical tasks such as patient case synthesis and research data abstraction. EMERSE, available free of charge for academic use, represents a state-of-the-art medical IR tool with proven effectiveness and user acceptance. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Stakeholder engagement: a key component of integrating genomic information into electronic health records

PubMed Central

Hartzler, Andrea; McCarty, Catherine A.; Rasmussen, Luke V.; Williams, Marc S.; Brilliant, Murray; Bowton, Erica A.; Clayton, Ellen Wright; Faucett, William A.; Ferryman, Kadija; Field, Julie R.; Fullerton, Stephanie M.; Horowitz, Carol R.; Koenig, Barbara A.; McCormick, Jennifer B.; Ralston, James D.; Sanderson, Saskia C.; Smith, Maureen E.; Trinidad, Susan Brown

2014-01-01

Integrating genomic information into clinical care and the electronic health record can facilitate personalized medicine through genetically guided clinical decision support. Stakeholder involvement is critical to the success of these implementation efforts. Prior work on implementation of clinical information systems provides broad guidance to inform effective engagement strategies. We add to this evidence-based recommendations that are specific to issues at the intersection of genomics and the electronic health record. We describe stakeholder engagement strategies employed by the Electronic Medical Records and Genomics Network, a national consortium of US research institutions funded by the National Human Genome Research Institute to develop, disseminate, and apply approaches that combine genomic and electronic health record data. Through select examples drawn from sites of the Electronic Medical Records and Genomics Network, we illustrate a continuum of engagement strategies to inform genomic integration into commercial and homegrown electronic health records across a range of health-care settings. We frame engagement as activities to consult, involve, and partner with key stakeholder groups throughout specific phases of health information technology implementation. Our aim is to provide insights into engagement strategies to guide genomic integration based on our unique network experiences and lessons learned within the broader context of implementation research in biomedical informatics. On the basis of our collective experience, we describe key stakeholder practices, challenges, and considerations for successful genomic integration to support personalized medicine. PMID:24030437

Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record

PubMed Central

Britton, John R.

2015-01-01

Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care. PMID:26340397

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

PubMed

Robles, Jane

2009-01-01

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

Development of an "Alert Framework" Based on the Practices in the Medical Front.

PubMed

Sakata, Takuya; Araki, Kenji; Yamazaki, Tomoyoshi; Kawano, Koichi; Maeda, Minoru; Kushima, Muneo; Araki, Sanae

2018-05-09

At the University of Miyazaki Hospital (UMH), we have accumulated and semantically structured a vast amount of medical information since the activation of the electronic health record system approximately 10 years ago. With this medical information, we have decided to develop an alert system for aiding in medical treatment. The purpose of this investigation is to not only to integrate an alert framework into the electronic heath record system, but also to formulate a modeling method of this knowledge. A trial alert framework was developed for the staff in various occupational categories at the UMH. Based on findings of subsequent interviews, a more detailed and upgraded alert framework was constructed, resulting in the final model. Based on our current findings, an alert framework was developed with four major items. Based on the analysis of the medical practices from the trial model, it has been concluded that there are four major risk patterns that trigger the alert. Furthermore, the current alert framework contains detailed definitions which are easily substituted into the database, leading to easy implementation of the electronic health records.

Release of VA Records Relating to HIV. Final rule.

PubMed

2017-03-23

The Department of Veterans Affairs (VA) is amending its medical regulations governing the release of VA medical records. Specifically, VA is eliminating the restriction on sharing a negative test result for the human immunodeficiency virus (HIV) with veterans' outside providers. HIV testing is a common practice today in healthcare and the stigma of testing that may have been seen in the 1980s when HIV was first discovered is no longer prevalent. Continuing to protect negative HIV tests causes delays and an unnecessary burden on veterans when VA tries to share electronic medical information with the veterans' outside providers through electronic health information exchanges. For this same reason, VA will also eliminate restrictions on negative test results of sickle cell anemia. This final rule eliminates the current barriers to electronic medical information exchange.

Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff.

PubMed

Morrison, Cecily; Jones, Matthew; Blackwell, Alan; Vuylsteke, Alain

2008-01-01

Electronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medical record. A qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews. Our analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions. We discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round.

Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff

PubMed Central

Morrison, Cecily; Jones, Matthew; Blackwell, Alan; Vuylsteke, Alain

2008-01-01

Introduction Electronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medical record. Methods A qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews. Results Our analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions. Conclusions We discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round. PMID:19025662

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

PubMed

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

2006-01-01

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

Using the Electronic Medical Record to Enhance Physician-Nurse Communication Regarding Patients' Discharge Status.

PubMed

Driscoll, Molly; Gurka, David

2015-01-01

The fast-paced environment of hospitals contributes to communication failures between health care providers while impacting patient care and patient flow. An effective mechanism for sharing patients' discharge information with health care team members is required to improve patient throughput. The communication of a patient's discharge plan was identified as crucial in alleviating patient flow delays at a tertiary care, academic medical center. By identifying the patients who were expected to be discharged the following day, the health care team could initiate discharge preparations in advance to improve patient care and patient flow. The patients' electronic medical record served to convey dynamic information regarding the patients' discharge status to the health care team via conditional discharge orders. Two neurosciences units piloted a conditional discharge order initiative. Conditional discharge orders were designed in the electronic medical record so that the conditions for discharge were listed in a dropdown menu. The health care team was trained on the conditional discharge order protocol, including when to write them, how to find them in the patients' electronic medical record, and what actions should be prompted by these orders. On average, 24% of the patients discharged had conditional discharge orders written the day before discharge. The average discharge time for patients with conditional discharge orders decreased by 83 minutes (0.06 day) from baseline. Qualitatively, the health care team reported improved workflows with conditional orders. The conditional discharge orders allowed physicians to communicate pending discharges electronically to the multidisciplinary team. The initiative positively impacted patient discharge times and workflows.

Integration of the enterprise electronic health record and anesthesia information management systems.

PubMed

Springman, Scott R

2011-09-01

Fewer than 5% of anesthesia departments use an electronic medical record (EMR) that is anesthesia specific. Many anesthesia information management systems (AIMS) have been developed with a focus only on the unique needs of anesthesia providers, without being fully integrated into other electronic health record components of the entire enterprise medical system. To understand why anesthesia providers should embrace health information technology (HIT) on a health system-wide basis, this article reviews recent HIT history and reviews HIT concepts. The author explores current developments in efforts to expand enterprise HIT, and the pros and cons of full enterprise integration with an AIMS. Copyright © 2011 Elsevier Inc. All rights reserved.

Effectiveness of a computerised system of patient education in clinical practice: a longitudinal nested cohort study.

PubMed

Su, Chia-Hsien; Li, Tsai-Chung; Cho, Der-Yang; Ma, Wei-Fen; Chang, Yu-Shan; Lee, Tsung-Han; Huang, Li-Chi

2018-05-03

Developing electronic health record information systems is an international trend for promoting the integration of health information and enhancing the quality of medical services. Patient education is a frequent intervention in nursing care, and recording the amount and quality of patient education have become essential in the nursing record. The aims of this study are (1): to develop a high-quality Patient Education Assessment and Description Record System (PEADRS) in the electronic medical record (2); to examine the effectiveness of the PEADRS on documentation and nurses' satisfaction (3); to facilitate communication and cooperation between professionals. A quasi-experimental design and random sampling will be used. The participants are nurses who are involved in patient education by using traditional record or the PEADRS at a medical centre. A prospective longitudinal nested cohort study will be conducted to compare the effectiveness of the PEADRS, including (1): the length of nursing documentation (2); satisfaction with using the PEADRS; and (3) the benefit to professional cooperation. Patient privacy will be protected according to Electronic Medical Record Management Practices of the hospital. This study develops a patient education digital record system, which would profit the quality of clinical practice in health education. The results will be published in peer-reviewed journals and will be presented at scientific conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Development of Markup Language for Medical Record Charting: A Charting Language.

PubMed

Jung, Won-Mo; Chae, Younbyoung; Jang, Bo-Hyoung

2015-01-01

Nowadays a lot of trials for collecting electronic medical records (EMRs) exist. However, structuring data format for EMR is an especially labour-intensive task for practitioners. Here we propose a new mark-up language for medical record charting (called Charting Language), which borrows useful properties from programming languages. Thus, with Charting Language, the text data described in dynamic situation can be easily used to extract information.

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

PubMed

Niimi, Yukari; Ota, Katsumasa

2017-02-01

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

New Optical Card for Sneaker’s Network in Place of Electronic Clinical Record

NASA Astrophysics Data System (ADS)

Goto, Kenya; Satsukawa, Takatoshi; Chiba, Seisho; Ohmori, Takaaki

2006-02-01

In order to solve problems in electronic medical records, a new optical card of the digital versatile disk (DVD) type with higher capacity and lower cost than conventional compact disc recording (CD-R)-type cards has been developed, which is thinner, stronger and wearable like a credit card.

Physician Interaction with Electronic Medical Records: A Qualitative Study

ERIC Educational Resources Information Center

Noteboom, Cherie Bakker

2010-01-01

The integration of EHR (Electronic Health Records) in IT infrastructures supporting organizations enable improved access to and recording of patient data, enhanced ability to make better and more-timely decisions, and improved quality and reduced errors. Despite these benefits, there are mixed results as to the use of EHR. The literature suggests…

A Simulated Hospital Pharmacy Module Using an Electronic Medical Record in a Pharmaceutical Care Skills Laboratory Course

PubMed Central

DiVall, Margarita V.; Guerra, Christina; Brown, Todd

2013-01-01

Objectives. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. Design. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. Assessments. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. Conclusions. A simulated hospital pharmacy module improved pharmacy students’ hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist. PMID:23610480

Challenges to ethics and professionalism facing the contemporary neurologist.

PubMed

Bernat, James L

2014-09-30

Challenges to ethics and professionalism that can harm neurologists and their patients include the commercialization of medicine, poorly designed Medicare regulations, conflicts of interest, physician employment by hospitals, faulty measurement of medical quality care, electronic health records, electronic communications with patients, and the demotion of the role of physician beneficence. These threats can lead to inaccurate medical record-keeping, unnecessary medical care, a decline in the primacy of patients' interests, and damage to the sanctity of the patient-physician relationship. The increasing frequency of physician burnout can be attributed at least partially to unmitigated stresses on practicing physicians, particularly the growing time pressures for patient visits, the mounting daily requirements of documentation, and the increasing burden of time-consuming but unproductive tasks. Recommended correctives include reforming billing documentation regulations, improving electronic health records, designing proper quality indicators integrating physician wellness, and incorporating reasonable physician workflows in the design of accountable care organizations. © 2014 American Academy of Neurology.

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…

RBAC-Matrix-based EMR right management system to improve HIPAA compliance.

PubMed

Lee, Hung-Chang; Chang, Shih-Hsin

2012-10-01

Security control of Electronic Medical Record (EMR) is a mechanism used to manage electronic medical records files and protect sensitive medical records document from information leakage. Researches proposed the Role-Based Access Control(RBAC). However, with the increasing scale of medical institutions, the access control behavior is difficult to have a detailed declaration among roles in RBAC. Furthermore, with the stringent specifications such as the U.S. HIPAA and Canada PIPEDA etc., patients are encouraged to have the right in regulating the access control of his EMR. In response to these problems, we propose an EMR digital rights management system, which is a RBAC-based extension to a matrix organization of medical institutions, known as RBAC-Matrix. With the aim of authorizing the EMR among roles in the organization, RBAC-Matrix also allow patients to be involved in defining access rights of his records. RBAC-Matrix authorizes access control declaration among matrix organizations of medical institutions by using XrML file in association with each EMR. It processes XrML rights declaration file-based authorization of behavior in the two-stage design, called master & servant stage, thus makes the associated EMR to be better protected. RBAC-Matrix will also make medical record file and its associated XrML declaration to two different EMRA(EMR Authorization)roles, namely, the medical records Document Creator (DC) and the medical records Document Right Setting (DRS). Access right setting, determined by the DRS, is cosigned by the patient, thus make the declaration of rights and the use of EMR to comply with HIPAA specifications.

Validation of electronic medical record-based phenotyping algorithms: results and lessons learned from the eMERGE network.

PubMed

Newton, Katherine M; Peissig, Peggy L; Kho, Abel Ngo; Bielinski, Suzette J; Berg, Richard L; Choudhary, Vidhu; Basford, Melissa; Chute, Christopher G; Kullo, Iftikhar J; Li, Rongling; Pacheco, Jennifer A; Rasmussen, Luke V; Spangler, Leslie; Denny, Joshua C

2013-06-01

Genetic studies require precise phenotype definitions, but electronic medical record (EMR) phenotype data are recorded inconsistently and in a variety of formats. To present lessons learned about validation of EMR-based phenotypes from the Electronic Medical Records and Genomics (eMERGE) studies. The eMERGE network created and validated 13 EMR-derived phenotype algorithms. Network sites are Group Health, Marshfield Clinic, Mayo Clinic, Northwestern University, and Vanderbilt University. By validating EMR-derived phenotypes we learned that: (1) multisite validation improves phenotype algorithm accuracy; (2) targets for validation should be carefully considered and defined; (3) specifying time frames for review of variables eases validation time and improves accuracy; (4) using repeated measures requires defining the relevant time period and specifying the most meaningful value to be studied; (5) patient movement in and out of the health plan (transience) can result in incomplete or fragmented data; (6) the review scope should be defined carefully; (7) particular care is required in combining EMR and research data; (8) medication data can be assessed using claims, medications dispensed, or medications prescribed; (9) algorithm development and validation work best as an iterative process; and (10) validation by content experts or structured chart review can provide accurate results. Despite the diverse structure of the five EMRs of the eMERGE sites, we developed, validated, and successfully deployed 13 electronic phenotype algorithms. Validation is a worthwhile process that not only measures phenotype performance but also strengthens phenotype algorithm definitions and enhances their inter-institutional sharing.

Contribution of Electronic Medical Records to the Management of Rare Diseases.

PubMed

Bremond-Gignac, Dominique; Lewandowski, Elisabeth; Copin, Henri

2015-01-01

Electronic health record systems provide great opportunity to study most diseases. Objective of this study was to determine whether electronic medical records (EMR) in ophthalmology contribute to management of rare eye diseases, isolated or in syndromes. Study was designed to identify and collect patients' data with ophthalmology-specific EMR. Ophthalmology-specific EMR software (Softalmo software Corilus) was used to acquire ophthalmological ocular consultation data from patients with five rare eye diseases. The rare eye diseases and data were selected and collected regarding expertise of eye center. A total of 135,206 outpatient consultations were performed between 2011 and 2014 in our medical center specialized in rare eye diseases. The search software identified 29 congenital aniridia, 6 Axenfeld/Rieger syndrome, 11 BEPS, 3 Nanophthalmos, and 3 Rubinstein-Taybi syndrome. EMR provides advantages for medical care. The use of ophthalmology-specific EMR is reliable and can contribute to a comprehensive ocular visual phenotype useful for clinical research. Routinely EMR acquired with specific software dedicated to ophthalmology provides sufficient detail for rare diseases. These software-collected data appear useful for creating patient cohorts and recording ocular examination, avoiding the time-consuming analysis of paper records and investigation, in a University Hospital linked to a National Reference Rare Center Disease.

Contribution of Electronic Medical Records to the Management of Rare Diseases

PubMed Central

Bremond-Gignac, Dominique; Lewandowski, Elisabeth; Copin, Henri

2015-01-01

Purpose. Electronic health record systems provide great opportunity to study most diseases. Objective of this study was to determine whether electronic medical records (EMR) in ophthalmology contribute to management of rare eye diseases, isolated or in syndromes. Study was designed to identify and collect patients' data with ophthalmology-specific EMR. Methods. Ophthalmology-specific EMR software (Softalmo software Corilus) was used to acquire ophthalmological ocular consultation data from patients with five rare eye diseases. The rare eye diseases and data were selected and collected regarding expertise of eye center. Results. A total of 135,206 outpatient consultations were performed between 2011 and 2014 in our medical center specialized in rare eye diseases. The search software identified 29 congenital aniridia, 6 Axenfeld/Rieger syndrome, 11 BEPS, 3 Nanophthalmos, and 3 Rubinstein-Taybi syndrome. Discussion. EMR provides advantages for medical care. The use of ophthalmology-specific EMR is reliable and can contribute to a comprehensive ocular visual phenotype useful for clinical research. Conclusion. Routinely EMR acquired with specific software dedicated to ophthalmology provides sufficient detail for rare diseases. These software-collected data appear useful for creating patient cohorts and recording ocular examination, avoiding the time-consuming analysis of paper records and investigation, in a University Hospital linked to a National Reference Rare Center Disease. PMID:26539543

Astronaut Health Participant Summary Application

NASA Technical Reports Server (NTRS)

Johnson, Kathy; Krog, Ralph; Rodriguez, Seth; Wear, Mary; Volpe, Robert; Trevino, Gina; Eudy, Deborah; Parisian, Diane

2011-01-01

The Longitudinal Study of Astronaut Health (LSAH) Participant Summary software captures data based on a custom information model designed to gather all relevant, discrete medical events for its study participants. This software provides a summarized view of the study participant s entire medical record. The manual collapsing of all the data in a participant s medical record into a summarized form eliminates redundancy, and allows for the capture of entire medical events. The coding tool could be incorporated into commercial electronic medical record software for use in areas like public health surveillance, hospital systems, clinics, and medical research programs.

Comparing the application of Health Information Technology in primary care in Denmark and Andalucía, Spain.

PubMed

Protti, Denis; Johansen, Ib; Perez-Torres, Francisco

2009-04-01

It is generally acknowledged that Denmark is one, if not the, leading country in terms of the use of information technology by its primary care physicians. Other countries, notably excluding the United States and Canada, are also advanced in terms of electronic medical records in general practitioner offices and clinics. This paper compares the status of primary care physician office computing in Andalucía to that of Denmark by contrasting the functionality of electronic medical records (EMRs) and the ability to electronically communicate clinical information in both jurisdictions. A novel scoring system has been developed based on data gathered from databases held by the respective jurisdictional programs, and interviews with individuals involved in the deployment of the systems. The scoring methodology was applied for the first time in a comparison of the degree of automation in primary care physician offices in Denmark and the province of Alberta in Canada. It was also used to compare Denmark and New Zealand. This paper is the third offering of this method of scoring the adoption of electronic medical records in primary care office settings which hopefully may be applicable to other health jurisdictions at national, state, or provincial levels. Although similar in many respects, there are significant differences between these two relatively autonomous health systems which have led to the rates of uptake of physician office computing. Particularly notable is the reality that the Danish primary care physicians have individual "Electronic Medical Records" while in Andalucía, the primary care physicians share a common record which when secondary care is fully implemented will indeed be an "Electronic Health Record". It is clear that the diffusion of technology, within the primary care physician sector of the health care market, is subject to historical, financial, legal, cultural, and social factors. This tale of two places illustrates the issues, and different ways that they have been addressed.

Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs.

PubMed

Pageler, Natalie M; Longhurst, Christopher A; Wood, Matthew; Cornfield, David N; Suermondt, Jaap; Sharek, Paul J; Franzon, Deborah

2014-03-01

We hypothesized that a checklist enhanced by the electronic medical record and a unit-wide dashboard would improve compliance with an evidence-based, pediatric-specific catheter care bundle and decrease central line-associated bloodstream infections (CLABSI). We performed a cohort study with historical controls that included all patients with a central venous catheter in a 24-bed PICU in an academic children's hospital. Postintervention CLABSI rates, compliance with bundle elements, and staff perceptions of communication were evaluated and compared with preintervention data. CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention. Analysis of specific bundle elements demonstrated increased daily documentation of line necessity from 30% to 73% (P < .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P < .001), increased compliance with port needle changes from 69% to 95% (P < .001), but decreased compliance with insertion bundle documentation from 67% to 62% (P = .001). Changes in the care plan were made during review of the electronic medical record checklist on 39% of patient rounds episodes. Use of an electronic medical record-enhanced CLABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidence-based catheter care and sustained decrease in CLABSI rates. These data underscore the potential for computerized interventions to promote compliance with proven best practices and prevent patient harm.

Constraints on Biological Mechanism from Disease Comorbidity Using Electronic Medical Records and Database of Genetic Variants

PubMed Central

Bagley, Steven C.; Sirota, Marina; Chen, Richard; Butte, Atul J.; Altman, Russ B.

2016-01-01

Patterns of disease co-occurrence that deviate from statistical independence may represent important constraints on biological mechanism, which sometimes can be explained by shared genetics. In this work we study the relationship between disease co-occurrence and commonly shared genetic architecture of disease. Records of pairs of diseases were combined from two different electronic medical systems (Columbia, Stanford), and compared to a large database of published disease-associated genetic variants (VARIMED); data on 35 disorders were available across all three sources, which include medical records for over 1.2 million patients and variants from over 17,000 publications. Based on the sources in which they appeared, disease pairs were categorized as having predominant clinical, genetic, or both kinds of manifestations. Confounding effects of age on disease incidence were controlled for by only comparing diseases when they fall in the same cluster of similarly shaped incidence patterns. We find that disease pairs that are overrepresented in both electronic medical record systems and in VARIMED come from two main disease classes, autoimmune and neuropsychiatric. We furthermore identify specific genes that are shared within these disease groups. PMID:27115429

Constraints on Biological Mechanism from Disease Comorbidity Using Electronic Medical Records and Database of Genetic Variants.

PubMed

Bagley, Steven C; Sirota, Marina; Chen, Richard; Butte, Atul J; Altman, Russ B

2016-04-01

Patterns of disease co-occurrence that deviate from statistical independence may represent important constraints on biological mechanism, which sometimes can be explained by shared genetics. In this work we study the relationship between disease co-occurrence and commonly shared genetic architecture of disease. Records of pairs of diseases were combined from two different electronic medical systems (Columbia, Stanford), and compared to a large database of published disease-associated genetic variants (VARIMED); data on 35 disorders were available across all three sources, which include medical records for over 1.2 million patients and variants from over 17,000 publications. Based on the sources in which they appeared, disease pairs were categorized as having predominant clinical, genetic, or both kinds of manifestations. Confounding effects of age on disease incidence were controlled for by only comparing diseases when they fall in the same cluster of similarly shaped incidence patterns. We find that disease pairs that are overrepresented in both electronic medical record systems and in VARIMED come from two main disease classes, autoimmune and neuropsychiatric. We furthermore identify specific genes that are shared within these disease groups.

Quality and correlates of medical record documentation in the ambulatory care setting

PubMed Central

Soto, Carlos M; Kleinman, Kenneth P; Simon, Steven R

2002-01-01

Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Methods We reviewed electronic medical records from 834 patients receiving care from 167 physicians (117 internists and 50 pediatricians) at 14 sites of a multi-specialty medical group in Massachusetts. We abstracted information for five measures of medical record documentation quality: smoking history, medications, drug allergies, compliance with screening guidelines, and immunizations. From other sources we determined physicians' specialty, gender, year of medical school graduation, and self-reported time spent teaching and in patient care. Results Among internists, unadjusted rates of documentation were 96.2% for immunizations, 91.6% for medications, 88% for compliance with screening guidelines, 61.6% for drug allergies, 37.8% for smoking history. Among pediatricians, rates were 100% for immunizations, 84.8% for medications, 90.8% for compliance with screening guidelines, 50.4% for drug allergies, and 20.4% for smoking history. While certain physician and patient characteristics correlated with some measures of documentation quality, documentation varied depending on the measure. For example, female internists were more likely than male internists to document smoking history (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.27 – 2.83) but were less likely to document drug allergies (OR, 0.51; 95% CI, 0.35 – 0.75). Conclusions Medical record documentation varied depending on the measure, with room for improvement in most domains. A variety of characteristics correlated with medical record documentation, but no pattern emerged. Further study could lead to targeted interventions to improve documentation. PMID:12473161

A web-based rapid prototyping and clinical conversational system that complements electronic patient record system.

PubMed

Kim, J H; Ferziger, R; Kawaloff, H B; Sands, D Z; Safran, C; Slack, W V

2001-01-01

Even the most extensive hospital information system cannot support all the complex and ever-changing demands associated with a clinical database, such as providing department or personal data forms, and rating scales. Well-designed clinical dialogue programs may facilitate direct interaction of patients with their medical records. Incorporation of extensive and loosely structured clinical data into an existing medical record system is an essential step towards a comprehensive clinical information system, and can best be achieved when the practitioner and the patient directly enter the contents. We have developed a rapid prototyping and clinical conversational system that complements the electronic medical record system, with its generic data structure and standard communication interfaces based on Web technology. We believe our approach can enhance collaboration between consumer-oriented and provider-oriented information systems.

MedEx: a medication information extraction system for clinical narratives

PubMed Central

Stenner, Shane P; Doan, Son; Johnson, Kevin B; Waitman, Lemuel R; Denny, Joshua C

2010-01-01

Medication information is one of the most important types of clinical data in electronic medical records. It is critical for healthcare safety and quality, as well as for clinical research that uses electronic medical record data. However, medication data are often recorded in clinical notes as free-text. As such, they are not accessible to other computerized applications that rely on coded data. We describe a new natural language processing system (MedEx), which extracts medication information from clinical notes. MedEx was initially developed using discharge summaries. An evaluation using a data set of 50 discharge summaries showed it performed well on identifying not only drug names (F-measure 93.2%), but also signature information, such as strength, route, and frequency, with F-measures of 94.5%, 93.9%, and 96.0% respectively. We then applied MedEx unchanged to outpatient clinic visit notes. It performed similarly with F-measures over 90% on a set of 25 clinic visit notes. PMID:20064797

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.

Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System.

PubMed

Rotich, Joseph K; Hannan, Terry J; Smith, Faye E; Bii, John; Odero, Wilson W; Vu, Nguyen; Mamlin, Burke W; Mamlin, Joseph J; Einterz, Robert M; Tierney, William M

2003-01-01

The authors implemented an electronic medical record system in a rural Kenyan health center. Visit data are recorded on a paper encounter form, eliminating duplicate documentation in multiple clinic logbooks. Data are entered into an MS-Access database supported by redundant power systems. The system was initiated in February 2001, and 10,000 visit records were entered for 6,190 patients in six months. The authors present a summary of the clinics visited, diagnoses made, drugs prescribed, and tests performed. After system implementation, patient visits were 22% shorter. They spent 58% less time with providers (p < 0.001) and 38% less time waiting (p = 0.06). Clinic personnel spent 50% less time interacting with patients, two thirds less time interacting with each other, and more time in personal activities. This simple electronic medical record system has bridged the "digital divide." Financial and technical sustainability by Kenyans will be key to its future use and development.

EMR management system for patient pulse data.

PubMed

Lee, Junyoung

2012-10-01

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

Assessing explicit error reporting in the narrative electronic medical record using keyword searching.

PubMed

Cao, Hui; Stetson, Peter; Hripcsak, George

2003-01-01

Many types of medical errors occur in and outside of hospitals, some of which have very serious consequences and increase cost. Identifying errors is a critical step for managing and preventing them. In this study, we assessed the explicit reporting of medical errors in the electronic record. We used five search terms "mistake," "error," "incorrect," "inadvertent," and "iatrogenic" to survey several sets of narrative reports including discharge summaries, sign-out notes, and outpatient notes from 1991 to 2000. We manually reviewed all the positive cases and identified them based on the reporting of physicians. We identified 222 explicitly reported medical errors. The positive predictive value varied with different keywords. In general, the positive predictive value for each keyword was low, ranging from 3.4 to 24.4%. Therapeutic-related errors were the most common reported errors and these reported therapeutic-related errors were mainly medication errors. Keyword searches combined with manual review indicated some medical errors that were reported in medical records. It had a low sensitivity and a moderate positive predictive value, which varied by search term. Physicians were most likely to record errors in the Hospital Course and History of Present Illness sections of discharge summaries. The reported errors in medical records covered a broad range and were related to several types of care providers as well as non-health care professionals.

Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population

PubMed Central

Kern, David M; Davis, Jill; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2015-01-01

Objective To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard. Methods Selecting from a repository containing members’ data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx–486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record. Results A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%–92.0%) versus 73.4% (95% CI: 66.8%–79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%–87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%–80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%–92.6%). Conclusion Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers can study pneumonia with confidence that claims data are a valid tool when studying the safety of COPD therapies that could potentially lead to increased pneumonia susceptibility or severity. PMID:26229461

Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population.

PubMed

Kern, David M; Davis, Jill; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2015-01-01

To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard. Selecting from a repository containing members' data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx-486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record. A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%-92.0%) versus 73.4% (95% CI: 66.8%-79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%-87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%-80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%-92.6%). Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers can study pneumonia with confidence that claims data are a valid tool when studying the safety of COPD therapies that could potentially lead to increased pneumonia susceptibility or severity.

Mobile agent application and integration in electronic anamnesis system.

PubMed

Liu, Chia-Hui; Chung, Yu-Fang; Chen, Tzer-Shyong; Wang, Sheng-De

2012-06-01

Electronic anamnesis is to transform ordinary paper trails to digitally formatted health records, which include the patient's general information, health status, and follow-ups on chronic diseases. Its main purpose is to let the records could be stored for a longer period of time and could be shared easily across departments and hospitals. Which means hospital management could use less resource on maintaining ever-growing database and reduce redundancy, so less money would be spent for managing the health records. In the foreseeable future, building up a comprehensive and integrated medical information system is a must, because it is critical to hospital resource integration and quality improvement. If mobile agent technology is adopted in the electronic anamnesis system, it would help the hospitals to make the medical practices more efficiently and conveniently. Nonetheless, most of the hospitals today are still using paper-based health records to manage the medical information. The reason why the institutions continue using traditional practices to manage the records is because there is no well-trusted and reliable electronic anamnesis system existing and accepted by both institutions and patients. The threat of privacy invasion is one of the biggest concerns when the topic of electronic anamnesis is brought up, because the security threats drag us back from using such a system. So, the medical service quality is difficult to be improved substantially. In this case, we have come up a theory to remove such security threats and make electronic anamnesis more appealing for use. Our theory is to integrate the mobile agent technology with the backbone of electronic anamnesis to construct a hierarchical access control system to retrieve the corresponding information based upon the permission classes. The system would create a classification for permission among the users inside the medical institution. Under this framework, permission control center would distribute an access key to each user, so they would only allow using the key to access information correspondingly. In order to verify the reliability of the proposed system framework, we have also conducted a security analysis to list all the possible security threats that may harm the system and to prove the system is reliable and safe. If the system is adopted, the doctors would be able to quickly access the information while performing medical examinations. Hence, the efficiency and quality of healthcare service would be greatly improved.

Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise's cross-enterprise document sharing integration profile.

PubMed

Wu, Chien Hua; Chiu, Ruey Kei; Yeh, Hong Mo; Wang, Da Wei

2017-11-01

In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service. In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise's Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system. The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system. The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios. Copyright © 2017 Elsevier B.V. All rights reserved.

77 FR 9902 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-21

... effective on March 22, 2012 unless comments are received that would result in a contrary determination... or status, name, Social Security Number (SSN), gender, medical diagnosis, medical condition, special...: Delete entry and replace with ``Paper records in file folders and electronic storage media...

Personal Health Records

MedlinePlus

... chart there, too. These charts are your medical records. They may be on paper or electronic. To ... good idea to keep your own personal health record. What kind of information would you put in ...

Dual function seal: visualized digital signature for electronic medical record systems.

PubMed

Yu, Yao-Chang; Hou, Ting-Wei; Chiang, Tzu-Chiang

2012-10-01

Digital signature is an important cryptography technology to be used to provide integrity and non-repudiation in electronic medical record systems (EMRS) and it is required by law. However, digital signatures normally appear in forms unrecognizable to medical staff, this may reduce the trust from medical staff that is used to the handwritten signatures or seals. Therefore, in this paper we propose a dual function seal to extend user trust from a traditional seal to a digital signature. The proposed dual function seal is a prototype that combines the traditional seal and digital seal. With this prototype, medical personnel are not just can put a seal on paper but also generate a visualized digital signature for electronic medical records. Medical Personnel can then look at the visualized digital signature and directly know which medical personnel generated it, just like with a traditional seal. Discrete wavelet transform (DWT) is used as an image processing method to generate a visualized digital signature, and the peak signal to noise ratio (PSNR) is calculated to verify that distortions of all converted images are beyond human recognition, and the results of our converted images are from 70 dB to 80 dB. The signature recoverability is also tested in this proposed paper to ensure that the visualized digital signature is verifiable. A simulated EMRS is implemented to show how the visualized digital signature can be integrity into EMRS.

Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record Comment on "Fee-for-Service Payment--an Evil Practice That Must Be Stamped Out?".

PubMed

Britton, John R

2015-05-08

Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care. © 2015 by Kerman University of Medical Sciences.

Management of laboratory data and information exchange in the electronic health record.

PubMed

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

2015-03-01

In the era of the electronic health record, the success of laboratories and pathologists will depend on effective presentation and management of laboratory information, including test orders and results, and effective exchange of data between the laboratory information system and the electronic health record. In this third paper of a series that explores empowerment of pathology in the era of the electronic health record, we review key elements of managing laboratory information within the electronic health record and examine functional issues pertinent to pathologists and laboratories in the exchange of laboratory information between electronic health records and both anatomic and clinical pathology laboratory information systems. Issues with electronic order-entry and results-reporting interfaces are described, and considerations for setting up these interfaces are detailed in tables. The role of the laboratory medical director as mandated by the Clinical Laboratory Improvement Amendments of 1988 and the impacts of discordance between laboratory results and their display in the electronic health record are also discussed.

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

PubMed

Papazissis, Elias

2014-01-01

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

Patients prefer electronic medical records - fact or fiction?

PubMed

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

2013-01-01

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

[Electronic patient record as the tool for better patient safety].

PubMed

Schneider, Henning

2015-01-01

Recent studies indicate again that there is a deficit in the use of electronic health records (EHR) in German hospitals. Despite good arguments in favour of their use, such as the rapid availability of data, German hospitals shy away from a wider implementation. The reason is the high cost of installing and maintaining the EHRs, for the benefit is difficult to evaluate in monetary terms for the hospital. Even if a benefit can be shown it is not necessarily evident within the hospital, but manifests itself only in the health system outside. Many hospitals only manage to partly implement EHR resulting in increased documentation requirements which reverse their positive effect.In the United States, electronic medical records are also viewed in light of their positive impact on patient safety. In particular, electronic medication systems prove the benefits they can provide in the context of patient safety. As a result, financing systems have been created to promote the digitalisation of hospitals in the United States. This has led to a large increase in the use of IT systems in the United States in recent years. The Universitätsklinikum Eppendorf (UKE) introduced electronic patient records in 2009. The benefits, in particular as regards patient safety, are numerous and there are many examples to illustrate this position. These positive results are intended to demonstrate the important role EHR play in hospitals. A financing system of the ailing IT landscape based on the American model is urgently needed to benefit-especially in terms of patient safety-from electronic medical records in the hospital.

Case Report Form Reporter: A Key Component for the Integration of Electronic Medical Records and the Electronic Data Capture System.

PubMed

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

2017-01-01

To improve the efficiency of clinical research, we developed a system to integrate electronic medical records (EMRs) and the electronic data capture system (EDC). EDC is divided into case report form (CRF) reporter and CDMS with CRF receiver with data communication using the operational data model (ODM). The CRF reporter is incorporated into the EMR to share data witth the EMR. In the data transcription type, doctors enter data using a progress note template, which are transmitted to the reporter template. It then generates the ODM. In the direct record type, reporter templates open from the progress note and generate narrative text to make record in the progress note. The configuration files for a study are delivered from the contents server to minimize the setup. This system has been used for 15 clinical studies including 3 clinical trials. This system can save labor and financial costs in clinical research.

Validation of a Delirium Risk Assessment Using Electronic Medical Record Information.

PubMed

Rudolph, James L; Doherty, Kelly; Kelly, Brittany; Driver, Jane A; Archambault, Elizabeth

2016-03-01

Identifying patients at risk for delirium allows prompt application of prevention, diagnostic, and treatment strategies; but is rarely done. Once delirium develops, patients are more likely to need posthospitalization skilled care. This study developed an a priori electronic prediction rule using independent risk factors identified in a National Center of Clinical Excellence meta-analysis and validated the ability to predict delirium in 2 cohorts. Retrospective analysis followed by prospective validation. Tertiary VA Hospital in New England. A total of 27,625 medical records of hospitalized patients and 246 prospectively enrolled patients admitted to the hospital. The electronic delirium risk prediction rule was created using data obtained from the patient electronic medical record (EMR). The primary outcome, delirium, was identified 2 ways: (1) from the EMR (retrospective cohort) and (2) clinical assessment on enrollment and daily thereafter (prospective participants). We assessed discrimination of the delirium prediction rule with the C-statistic. Secondary outcomes were length of stay and discharge to rehabilitation. Retrospectively, delirium was identified in 8% of medical records (n = 2343); prospectively, delirium during hospitalization was present in 26% of participants (n = 64). In the retrospective cohort, medical record delirium was identified in 2%, 3%, 11%, and 38% of the low, intermediate, high, and very high-risk groups, respectively (C-statistic = 0.81; 95% confidence interval 0.80-0.82). Prospectively, the electronic prediction rule identified delirium in 15%, 18%, 31%, and 55% of these groups (C-statistic = 0.69; 95% confidence interval 0.61-0.77). Compared with low-risk patients, those at high- or very high delirium risk had increased length of stay (5.7 ± 5.6 vs 3.7 ± 2.7 days; P = .001) and higher rates of discharge to rehabilitation (8.9% vs 20.8%; P = .02). Automatic calculation of delirium risk using an EMR algorithm identifies patients at risk for delirium, which creates a critical opportunity for gaining clinical efficiencies and improving delirium identification, including those needing skilled care. Published by Elsevier Inc.

Cancer patients' attitudes and experiences of online access to their electronic medical records: A qualitative study.

PubMed

Rexhepi, Hanife; Åhlfeldt, Rose-Mharie; Cajander, Åsa; Huvila, Isto

2018-06-01

Patients' access to their online medical records serves as one of the cornerstones in the efforts to increase patient engagement and improve healthcare outcomes. The aim of this article is to provide in-depth understanding of cancer patients' attitudes and experiences of online medical records, as well as an increased understanding of the complexities of developing and launching e-Health services. The study result confirms that online access can help patients prepare for doctor visits and to understand their medical issues. In contrast to the fears of many physicians, the study shows that online access to medical records did not generate substantial anxiety, concerns or increased phone calls to the hospital.

Electronic health systems: challenges faced by hospital-based providers.

PubMed

Agno, Christina Farala; Guo, Kristina L

2013-01-01

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

Recognition and privacy preservation of paper-based health records.

PubMed

Fenz, Stefan; Heurix, Johannes; Neubauer, Thomas

2012-01-01

While the digitization of medical data within electronic health records has been introduced in some areas, massive amounts of paper-based health records are still produced on a daily basis. This data has to be stored for decades due to legal reasons but is of no benefit for research organizations, as the unstructured medical data in paper-based health records cannot be efficiently used for clinical studies. This paper presents a system for the recognition and privacy preservation of personal data in paper-based health records with the aim to provide clinical studies with medical data gained from existing paper-based health records.

Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.

PubMed

Elliott, Rohan A; Lee, Cik Yin; Hussainy, Safeera Y

2016-06-01

Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners' orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers' orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers' electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility's pharmacy, could improve patient safety.

Electronic Medical Records in Greece and Oman: A Professional's Evaluation of Structure and Value.

PubMed

Koutzampasopoulou Xanthidou, Ourania; Shuib, Liyana; Xanthidis, Dimitrios; Nicholas, David

2018-06-01

An Electronic Medical Record (EMR) is a patient's database record that can be transmitted securely. There are a diversity of EMR systems for different medical units to choose from. The structure and value of these systems is the focus of this qualitative study, from a medical professional's standpoint, as well as its economic value and whether it should be shared between health organizations. The study took place in the natural setting of the medical units' environments. A purposive sample of 40 professionals in Greece and Oman, was interviewed. The study suggests that: (1) The demographics of the EMR should be divided in categories, not all of them accessible and/or visible by all; (2) The EMR system should follow an open architecture so that more categories and subcategories can be added as needed and following a possible business plan (ERD is suggested); (3) The EMR should be implemented gradually bearing in mind both medical and financial concerns; (4) Sharing should be a patient's decision as the owner of the record. Reaching a certain level of maturity of its implementation and utilization, it is useful to seek the professionals' assessment on the structure and value of such a system.

Deconstructing Clinical Workflow: Identifying Teaching-Learning Principles for Barcode Electronic Medication Administration With Nursing Students.

PubMed

Booth, Richard G; Sinclair, Barbara; Strudwick, Gillian; Brennan, Laura; Morgan, Lisa; Collings, Stephanie; Johnston, Jessica; Loggie, Brittany; Tong, James; Singh, Chantal

The purpose of this quality improvement project was to better understand how to teach medication administration underpinned by an electronic medication administration record (eMAR) system used in simulated, prelicensure nursing education. Methods included a workflow and integration analysis and a detailed process mapping of both an oral and a sublingual medication administration. Procedural and curriculum development considerations related to medication administration using eMAR technology are presented for nurse educators.

Evaluation of the mining techniques in constructing a traditional Chinese-language nursing recording system.

PubMed

Liao, Pei-Hung; Chu, William; Chu, Woei-Chyn

2014-05-01

In 2009, the Department of Health, part of Taiwan's Executive Yuan, announced the advent of electronic medical records to reduce medical expenses and facilitate the international exchange of medical record information. An information technology platform for nursing records in medical institutions was then quickly established, which improved nursing information systems and electronic databases. The purpose of the present study was to explore the usability of the data mining techniques to enhance completeness and ensure consistency of nursing records in the database system.First, the study used a Chinese word-segmenting system on common and special terms often used by the nursing staff. We also used text-mining techniques to collect keywords and create a keyword lexicon. We then used an association rule and artificial neural network to measure the correlation and forecasting capability for keywords. Finally, nursing staff members were provided with an on-screen pop-up menu to use when establishing nursing records. Our study found that by using mining techniques we were able to create a powerful keyword lexicon and establish a forecasting model for nursing diagnoses, ensuring the consistency of nursing terminology and improving the nursing staff's work efficiency and productivity.

Bidirectional RNN for Medical Event Detection in Electronic Health Records.

PubMed

Jagannatha, Abhyuday N; Yu, Hong

2016-06-01

Sequence labeling for extraction of medical events and their attributes from unstructured text in Electronic Health Record (EHR) notes is a key step towards semantic understanding of EHRs. It has important applications in health informatics including pharmacovigilance and drug surveillance. The state of the art supervised machine learning models in this domain are based on Conditional Random Fields (CRFs) with features calculated from fixed context windows. In this application, we explored recurrent neural network frameworks and show that they significantly out-performed the CRF models.

Strategies to accelerate translation of research into primary care within practices using electronic medical records.

PubMed

Nemeth, Lynne S; Wessell, Andrea M; Jenkins, Ruth G; Nietert, Paul J; Liszka, Heather A; Ornstein, Steven M

2007-01-01

This research describes implementation strategies used by primary care practices using electronic medical records in a national quality improvement demonstration project, Accelerating Translation of Research into Practice, conducted within the Practice Partner Research Network. Qualitative methods enabled identification of strategies to improve 36 quality indicators. Quantitative survey results provide mean scores reflecting the integration of these strategies by practices. Nursing staff plays important roles to facilitate quality improvement within collaborative primary care practices.

Know me - a journey in creating a personal electronic health record.

PubMed

Buckley, Amanda; Fox, Suzanne

2015-01-01

KnowMe is a patient created personal story of key life events both medical and non-medical that enables clinicians to understand what matters to the patient, not what's the matter with them. By shifting the Electronic Health Record (EHR) focus to knowing when a patient was at their best, what's important to them, their personal health goals, and care preferences, clinicians and patients can collaboratively work together in creating a treatment plan that aligns resources tailored to the their needs.

A Document-Based EHR System That Controls the Disclosure of Clinical Documents Using an Access Control List File Based on the HL7 CDA Header.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Nakagawa, Akito; Manabe, Shirou; Okada, Katsuki; Mihara, Naoki; Matsumura, Yasushi

2017-01-01

Electronic health record (EHR) systems are necessary for the sharing of medical information between care delivery organizations (CDOs). We developed a document-based EHR system in which all of the PDF documents that are stored in our electronic medical record system can be disclosed to selected target CDOs. An access control list (ACL) file was designed based on the HL7 CDA header to manage the information that is disclosed.

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

PubMed

Winkelman, Warren J; Leonard, Kevin J

2004-01-01

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

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…

Using a medical simulation center as an electronic health record usability laboratory

PubMed Central

Landman, Adam B; Redden, Lisa; Neri, Pamela; Poole, Stephen; Horsky, Jan; Raja, Ali S; Pozner, Charles N; Schiff, Gordon; Poon, Eric G

2014-01-01

Usability testing is increasingly being recognized as a way to increase the usability and safety of health information technology (HIT). Medical simulation centers can serve as testing environments for HIT usability studies. We integrated the quality assurance version of our emergency department (ED) electronic health record (EHR) into our medical simulation center and piloted a clinical care scenario in which emergency medicine resident physicians evaluated a simulated ED patient and documented electronically using the ED EHR. Meticulous planning and close collaboration with expert simulation staff was important for designing test scenarios, pilot testing, and running the sessions. Similarly, working with information systems teams was important for integration of the EHR. Electronic tools are needed to facilitate entry of fictitious clinical results while the simulation scenario is unfolding. EHRs can be successfully integrated into existing simulation centers, which may provide realistic environments for usability testing, training, and evaluation of human–computer interactions. PMID:24249778

Measuring the success of electronic medical record implementation using electronic and survey data.

PubMed Central

Keshavjee, K.; Troyan, S.; Holbrook, A. M.; VanderMolen, D.

2001-01-01

Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically. PMID:11825201

USE OF ELECTRONIC HEALTH RECORDS TO CHARACTERIZE A RARE DISEASE IN THE U.S.: TREATMENT, COMORBIDITIES, AND FOLLOW-UP TRENDS AMONG PATIENTS WITH A CONFIRMED DIAGNOSIS OF ACROMEGALY.

PubMed

Silverstein, Julie M; Roe, Erin D; Munir, Kashif M; Fox, Janet L; Emir, Birol; Kouznetsova, Maria; Lamerato, Lois E; King, Donna

2018-06-01

Understanding of acromegaly disease management is hampered in the U.S. by the lack of a national registry. We describe medical management in a population with confirmed acromegaly. Inpatient and outpatient electronic health records (EHRs) were used to create a database of de-identified patients assigned the Acromegaly and Gigantism International Classification of Diseases, 9 th revision (ICD-9) code and/or an appropriate pituitary procedure code at 1 of 4 regional hospital systems over a 6- to 11-year period. Information regarding demographics, medical history, labs, procedures, and medications was collected and supplemented with a chart review to validate the diagnosis of acromegaly. Of 367 patients with validated acromegaly, available records showed that during the years studied, pituitary surgery was performed on 31%, 4% received radiosurgery, and 22% were prescribed a drug indicated for acromegaly. Insulin-like growth factor-1 (IGF-1) levels were measured in 62% of patients, 83% of whom had at least 1 normal value. Coded comorbidities reflect those reported previously in patients with acromegaly, with the exception of esophageal reflux in 20% of patient records. Fewer data regarding acromegaly-specific medications and testing were available for patients aged 65 and older. AcroMEDIC is a U.S. multisite retrospective study of acromegaly that captured medical management in the majority of patients included in the cohort. Chart review highlighted the importance of verification of coded diagnoses. Most of the acromegaly-related comorbidities identified here are known to increase with age and obesity. Patients ≥65 appeared to have less active management/monitoring of their disease. Medical attention should be directed to this population to address evolving needs over time. AcroMEDIC = Acromegaly Multisite Electronic Data Innovative Consortium; BMI = body mass index; CCI = Charlson Comorbidity Index; EHR = electronic health record; GH = growth hormone; GHRA = growth hormone receptor antagonist; ICD-9 = International Classification of Diseases, 9 th revision; IGF-1 = insulin-like growth factor-1; SSA = somatostatin analogue.

Extended use of electronic health records by primary care physicians: Does the electronic health record artefact matter?

PubMed

Raymond, Louis; Paré, Guy; Marchand, Marie

2017-04-01

The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes. Significant differences were observed among the three products with regard to their functional capability. The extent to which each of the electronic health record functionalities are used by physicians also varied significantly. Our results confirm that the electronic health record artefact 'does matter', its clinical functionalities explaining why certain physicians make more extended use of their system than others.

A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment

PubMed Central

2017-01-01

In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR) system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients' medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients) are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed. PMID:28280506

Characteristics and Associated Comorbidities of Pediatric Dental Patients Treated under General Anesthesia.

PubMed

Delfiner, Alexandra; Myers, Aaron; Lumsden, Christie; Chussid, Steve; Yoon, Richard

To describe characteristics and identify common comorbidities of children receiving dental treatment under general anesthesia at Children's Hospital of New York-Presbyterian. Electronic medical records of all children that received dental treatment under general anesthesia through the Division of Pediatric Dentistry from 2012-2014 were reviewed. Data describing patient characteristics (age, sex, race/ethnicity, insurance carrier, and American Society of Anesthesiologists physical status classification system), medical history, and justification for treatment were collected. Descriptive statistics, including frequencies, percentages and t-tests, were calculated. A total of 298 electronic medical records were reviewed, of which 50 records were excluded due to missing information. Of the 248 electronic medical records included, the average age was 5-years-old and 58% were male. The most common reason for dental treatment under general anesthesia was extent and severity of dental disease (53%), followed by significant medical history (47%) and behavior/pre-cooperative age (39%). Those who were ASA III or IV were older (6.6-years) (p<.001). Common medical comorbidities appear evenly distributed: autism (12%), cardiac anomalies (14%), developmental delay (14%), genetic syndromes/chromosomal disorders (13%), and neurological disorders (12%). Younger age groups (1 to 2 years and 3 to 5 years) had a high percentage of hospitalizations due to the extent and severity of the dental disease (83%) and behavior (77%) (p<0.001). No single comorbidity was seen more often than others in this patient population. The range of medical conditions in this population may be a reflection of the range of pediatric specialty services at Children's Hospital of NewYork-Presbyterian.

Improving Care for Patients With or at Risk for Chronic Kidney Disease Using Electronic Medical Record Interventions: A Pragmatic Cluster-Randomized Trial Protocol

PubMed Central

Nash, Danielle M.; Ivers, Noah M.; Young, Jacqueline; Jaakkimainen, R. Liisa; Garg, Amit X.; Tu, Karen

2017-01-01

Background: Many patients with or at risk for chronic kidney disease (CKD) in the primary care setting are not receiving recommended care. Objective: The objective of this study is to determine whether a multifaceted, low-cost intervention compared with usual care improves the care of patients with or at risk for CKD in the primary care setting. Design: A pragmatic cluster-randomized trial, with an embedded qualitative process evaluation, will be conducted. Setting: The study population comes from the Electronic Medical Record Administrative data Linked Database®, which includes clinical data for more than 140 000 rostered adults cared for by 194 family physicians in 34 clinics across Ontario, Canada. The 34 primary care clinics will be randomized to the intervention or control group. Intervention: The intervention group will receive resources from the “CKD toolkit” to help improve care including practice audit and feedback, printed educational materials for physicians and patients, electronic decision support and reminders, and implementation support. Measurements: Patients with or at risk for CKD within participating clinics will be identified using laboratory data in the electronic medical records. Outcomes will be assessed after dissemination of the CKD tools and after 2 rounds of feedback on performance on quality indicators have been sent to the physicians using information from the electronic medical records. The primary outcome is the proportion of patients aged 50 to 80 years with nondialysis-dependent CKD who are on a statin. Secondary outcomes include process of care measures such as screening tests, CKD recognition, monitoring tests, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker prescriptions, blood pressure targets met, and nephrologist referral. Hierarchical analytic modeling will be performed to account for clustering. Semistructured interviews will be conducted with a random purposeful sample of physicians in the intervention group to understand why the intervention achieved the observed effects. Conclusions: If our intervention improves care, then the CKD toolkit can be adapted and scaled for use in other primary care clinics which use electronic medical records. Trial Registration: ClinicalTrials.gov Identifier: NCT02274298 PMID:28607686

77 FR 64387 - Agency Information Collection (Request for and Authorization To Release Medical Records or Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-19

... Protected Health Information to Nationwide Health Information Network, VA Form 10-0485. OMB Control Number... electronically exchange protected health information between VA and approved Nationwide Health Information... for and Authorization To Release Medical Records or Health Information) Activities Under OMB Review...

A clinically useful diabetes electronic medical record: lessons from the past; pointers toward the future.

PubMed

Gorman, C; Looker, J; Fisk, T; Oelke, W; Erickson, D; Smith, S; Zimmerman, B

1996-01-01

We have analysed the deficiencies of paper medical records in facilitating the care of patients with diabetes and have developed an electronic medical record that corrects some of them. The diabetes electronic medical record (DEMR) is designed to facilitate the work of a busy diabetes clinic. Design principles include heavy reliance on graphic displays of laboratory and clinical data, consistent color coding and aggregation of data needed to facilitate the different types of clinical encounter (initial consultation, continuing care visit, insulin adjustment visit, dietitian encounter, nurse educator encounter, obstetric patient, transplant patient, visits for problems unrelated to diabetes). Data input is by autoflow from the institutional laboratories, by desk attendants or on-line by all users. Careful attention has been paid to making data entry a point and click process wherever possible. Opportunity for free text comment is provided on every screen. On completion of the encounter a narrative text summary of the visit is generated by the computer and is annotated by the care giver. Currently there are about 7800 patients in the system. Remaining challenges include the adaptation of the system to accommodate the occasional user, development of portable laptop derivatives that remain compatible with the parent system and improvements in the screen structure and graphic display formats.

Development and validation of an electronic phenotyping algorithm for chronic kidney disease

PubMed Central

Nadkarni, Girish N; Gottesman, Omri; Linneman, James G; Chase, Herbert; Berg, Richard L; Farouk, Samira; Nadukuru, Rajiv; Lotay, Vaneet; Ellis, Steve; Hripcsak, George; Peissig, Peggy; Weng, Chunhua; Bottinger, Erwin P

2014-01-01

Twenty-six million Americans are estimated to have chronic kidney disease (CKD) with increased risk for cardiovascular disease and end stage renal disease. CKD is frequently undiagnosed and patients are unaware, hampering intervention. A tool for accurate and timely identification of CKD from electronic medical records (EMR) could improve healthcare quality and identify patients for research. As members of eMERGE (electronic medical records and genomics) Network, we developed an automated phenotyping algorithm that can be deployed to identify rapidly diabetic and/or hypertensive CKD cases and controls in health systems with EMRs It uses diagnostic codes, laboratory results, medication and blood pressure records, and textual information culled from notes. Validation statistics demonstrated positive predictive values of 96% and negative predictive values of 93.3. Similar results were obtained on implementation by two independent eMERGE member institutions. The algorithm dramatically outperformed identification by ICD-9-CM codes with 63% positive and 54% negative predictive values, respectively. PMID:25954398

[Local communalization of clinical records between the municipal community hospital and local medical institutes by using information technology].

PubMed

Iijima, Shohei; Shinoki, Keiji; Ibata, Takeshi; Nakashita, Chisako; Doi, Seiko; Hidaka, Kumi; Hata, Akiko; Matsuoka, Mio; Waguchi, Hideko; Mito, Saori; Komuro, Ryutaro

2012-12-01

We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics.

Reducing warfarin medication interactions: an interrupted time series evaluation.

PubMed

Feldstein, Adrianne C; Smith, David H; Perrin, Nancy; Yang, Xiuhai; Simon, Steven R; Krall, Michael; Sittig, Dean F; Ditmer, Diane; Platt, Richard; Soumerai, Stephen B

2006-05-08

Computerized decision support reduces medication errors in inpatients, but limited evidence supports its effectiveness in reducing the coprescribing of interacting medications, especially in the outpatient setting. The usefulness of academic detailing to enhance the effectiveness of medication interaction alerts also is uncertain. This study used an interrupted time series design. In a health maintenance organization with an electronic medical record, we evaluated the effectiveness of electronic medical record alerts and group academic detailing to reduce the coprescribing of warfarin and interacting medications. Participants were 239 primary care providers at 15 primary care clinics and 9910 patients taking warfarin. All 15 clinics received electronic medical record alerts for the coprescription of warfarin and 5 interacting medications: acetaminophen, nonsteroidal anti-inflammatory medications, fluconazole, metronidazole, and sulfamethoxazole. Seven clinics were randomly assigned to receive group academic detailing. The primary outcome, the interacting prescription rate (ie, the number of coprescriptions of warfarin-interacting medications per 10 000 warfarin users per month), was analyzed with segmented regression models, controlling for preintervention trends. At baseline, nearly a third of patients had an interacting prescription. Coinciding with the alerts, there was an immediate and continued reduction in the warfarin-interacting medication prescription rate (from 3294.0 to 2804.2), resulting in a 14.9% relative reduction (95% confidence interval, -19.5 to -10.2) at 12 months. Group academic detailing did not enhance alert effectiveness. This study, using a strong and quasi-experimental design in ambulatory care, found that medication interaction alerts modestly reduced the frequency of coprescribing of interacting medications. Additional efforts will be required to further reduce rates of inappropriate prescribing of warfarin with interacting drugs.

Toward Improved Security and Privacy in Modern Healthcare

ERIC Educational Resources Information Center

Pagano, Matthew Wallach

2013-01-01

The conversion of paper-based medical records into electronic formats is set to bring many benefits to healthcare. This includes creating a more seamless exchange of electronic health records (EHRs) between providers, improving healthcare while lowering its costs, and providing patients with increased access to their EHRs. As more medical…

Toward an integrated computerized patient record.

PubMed

Dole, T R; Luberti, A A

2000-04-01

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

Critical issues in an electronic documentation system.

PubMed

Weir, Charlene R; Nebeker, Jonathan R

2007-10-11

The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs has instituted a medical record (EMR) that includes electronic documentation of all narrative components of the medical record. To support clinicians using the system, multiple efforts have been instituted to ease the creation of narrative reports. Although electronic documentation is easier to read and improves access to information, it also may create new and additional hazards for users. This study is the first step in a series of studies to evaluate the issues surrounding the creation and use of electronic documentation. Eighty-eight providers across multiple clinical roles were interviewed in 10 primary care sites in the VA system. Interviews were tape-recorded, transcribed and qualitatively analyzed for themes. In addition, specific questions were asked about perceived harm due to electronic documentation practices. Five themes relating to difficulties with electronic documentation were identified: 1) information overload; 2) hidden information; 3) lack of trust; 4) communication; 5) decision-making. Three providers reported that they knew of an incident where current documentation practices had caused patient harm and over 75% of respondents reported significant mis-trust of the system.

Building Structured Personal Health Records from Photographs of Printed Medical Records.

PubMed

Li, Xiang; Hu, Gang; Teng, Xiaofei; Xie, Guotong

2015-01-01

Personal health records (PHRs) provide patient-centric healthcare by making health records accessible to patients. In China, it is very difficult for individuals to access electronic health records. Instead, individuals can easily obtain the printed copies of their own medical records, such as prescriptions and lab test reports, from hospitals. In this paper, we propose a practical approach to extract structured data from printed medical records photographed by mobile phones. An optical character recognition (OCR) pipeline is performed to recognize text in a document photo, which addresses the problems of low image quality and content complexity by image pre-processing and multiple OCR engine synthesis. A series of annotation algorithms that support flexible layouts are then used to identify the document type, entities of interest, and entity correlations, from which a structured PHR document is built. The proposed approach was applied to real world medical records to demonstrate the effectiveness and applicability.

Building Structured Personal Health Records from Photographs of Printed Medical Records

PubMed Central

Li, Xiang; Hu, Gang; Teng, Xiaofei; Xie, Guotong

2015-01-01

Personal health records (PHRs) provide patient-centric healthcare by making health records accessible to patients. In China, it is very difficult for individuals to access electronic health records. Instead, individuals can easily obtain the printed copies of their own medical records, such as prescriptions and lab test reports, from hospitals. In this paper, we propose a practical approach to extract structured data from printed medical records photographed by mobile phones. An optical character recognition (OCR) pipeline is performed to recognize text in a document photo, which addresses the problems of low image quality and content complexity by image pre-processing and multiple OCR engine synthesis. A series of annotation algorithms that support flexible layouts are then used to identify the document type, entities of interest, and entity correlations, from which a structured PHR document is built. The proposed approach was applied to real world medical records to demonstrate the effectiveness and applicability. PMID:26958219

[Security specifications for electronic medical records on the Internet].

PubMed

Mocanu, Mihai; Mocanu, Carmen

2007-01-01

The extension for the Web applications of the Electronic Medical Record seems both interesting and promising. Correlated with the expansion of Internet in our country, it allows the interconnection of physicians of different specialties and their collaboration for better treatment of patients. In this respect, the ophthalmologic medical applications consider the increased possibilities for monitoring chronic ocular diseases and for the identification of some elements for early diagnosis and risk factors supervision. We emphasize in this survey some possible solutions to the problems of interconnecting medical information systems to the Internet: the achievement of interoperability within medical organizations through the use of open standards, the automated input and processing for ocular imaging, the use of data reduction techniques in order to increase the speed of image retrieval in large databases, and, last but not least, the resolution of security and confidentiality problems in medical databases.

An inventory of publications on electronic medical records revisited.

PubMed

Moorman, P W; Schuemie, M J; van der Lei, J

2009-01-01

In this short review we provide an update of our earlier inventories of publications indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. We retrieved and analyzed all references to English articles published before January 1, 2008, and indexed in PubMed with the MeSH term 'Medical Records Systems, Computerized'. We retrieved a total of 11,924 publications, of which 3937 (33%) appeared in a journal with an impact factor. Since 2002 the number of yearly publications, and the number of journals in which those publications appeared, increased. A cluster analysis revealed three clusters: an organizational issues cluster, a technically oriented cluster and a cluster about order-entry and research. Although our previous inventory in 2003 suggested a constant yearly production of publications on electronic medical records since 1998, the current inventory shows another rise in production since 2002. In addition, many new journals and countries have shown interest during the last five years. In the last 15 years, interest in organizational issues remained fairly constant, order entry and research with systems gained attention, while interest in technical issues relatively decreased.

Beneficial Effects of Two Types of Personal Health Record Services Connected With Electronic Medical Records Within the Hospital Setting.

PubMed

Lee, Jisan; Kim, James G Boram; Jin, Meiling; Ahn, Kiwhan; Kim, Byungjun; Kim, Sukwha; Kim, Jeongeun

2017-11-01

Healthcare consumers must be able to make decisions based on accurate health information. To assist with this, we designed and developed an integrated system connected with electronic medical records in hospitals to ensure delivery of accurate health information. The system-called the Consumer-centered Open Personal Health Record platform-is composed of two services: a portal for users with any disease and a mobile application for users with cleft lip/palate. To assess the benefits of these services, we used a quasi-experimental, pretest-posttest design, assigning participants to the portal (n = 50) and application (n = 52) groups. Both groups showed significantly increased knowledge, both objective (actual knowledge of health information) and subjective (perceived knowledge of health information), after the intervention. Furthermore, while both groups showed higher information needs satisfaction after the intervention, the application group was significantly more satisfied. Knowledge changes were more affected by participant characteristics in the application group. Our results may be due to the application's provision of specific disease information and a personalized treatment plan based on the participant and other users' data. We recommend that services connected with electronic medical records target specific diseases to provide personalized health management to patients in a hospital setting.

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

PubMed

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

2005-01-01

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

Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success.

PubMed

Murphy, Elizabeth V

2014-06-01

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the "meaningful use" of electronic medical record systems. An important component of the "Meaningful Use" legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Application of an Electronic Medical Record in Space Medicine

NASA Technical Reports Server (NTRS)

McGinnis, Patrick J.

2000-01-01

Electronic Medical Records (EMR) have been emerging over the past decade. Today, they are replacing the paper chart in clinics throughout the nation. Approximately three years ago, the NASA-JSC Flight Medicine Clinic initiated an assessment of the EMRs available on the market. This assessment included comparing these products with the particular scope of practice at JSC. In 1998, the Logician EMR from Medicalogic was selected for the JSC Flight Medicine Clinic. This presentation reviews the process of selection and implementation of the EMR into the unique practice of aerospace medicine at JSC.

Accuracy of using Diagnosis Procedure Combination administrative claims data for estimating the amount of opioid consumption among cancer patients in Japan.

PubMed

Iwamoto, Momoko; Higashi, Takahiro; Miura, Hiroki; Kawaguchi, Takahiro; Tanaka, Shigeyuki; Yamashita, Itsuku; Yoshimoto, Tetsusuke; Yoshida, Shigeaki; Matoba, Motohiro

2015-11-01

The state of opioid consumption among cancer patients has never been comprehensively investigated in Japan. The Diagnosis Procedure Combination claims data may be used to measure and monitor opioid consumption among cancer patients, but the accuracy of using the Diagnosis Procedure Combination data for this purpose has never been tested. We aimed to ascertain the accuracy of using the Diagnosis Procedure Combination claims data for estimating total opioid analgesic consumption by cancer patients compared with electronic medical records at Aomori Prefectural Central Hospital. We calculated percent differences between estimates obtained from electronic medical records and Diagnosis Procedure Combination claims data by month and drug type (morphine, oxycodone, fentanyl, buprenorphine, codeine and tramadol) between 1 October 2012 and 30 September 2013, and further examined the causes of discrepancy by reviewing medical and administrative charts between April and July 2013. Percent differences varied by month for drug types with small prescription volumes, but less so for drugs with larger prescription volumes. Differences also tended to diminish when consumption was compared for a year instead of a month. Total percent difference between electronic medical records and Diagnosis Procedure Combination data during the study period was -0.1% (4721 mg per year per hospital), as electronic medical records as baseline. Half of the discrepancy was caused by errors in data entry. Our study showed that Diagnosis Procedure Combination claims data can be used to accurately estimate opioid consumption among a population of cancer patients, although the same conclusion cannot be made for individual estimates or when making estimates for a group of patients over a short period of time. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

An observational analysis of provider adherence to AUA guidelines on the management of benign prostatic hyperplasia.

PubMed

Auffenberg, Gregory B; Gonzalez, Chris M; Wolf, J Stuart; Clemens, J Quentin; Meeks, William; McVary, Kevin T

2014-11-01

We retrospectively evaluated urologist adherence to the AUA guidelines on the management of new patients with benign prostatic hyperplasia related lower urinary tract symptoms in a large university urology group. All first time benign prostatic hyperplasia/lower urinary tract symptom visits to the urology clinic at the Northwestern Medical Faculty Foundation between January 1, 2008 and December 31, 2012 were evaluated using an institutionally managed electronic medical record data repository. Clinical documentation and orders from each encounter were assessed to determine the rate of performance of guideline measures. Approximately 1% of all results were manually reviewed in a validation process designed to determine the reliability of the electronic medical record based system. A total of 3,494 eligible encounters were evaluated in the final analysis. Provider adherence rates with the 9 measures recommended in the guidelines varied by measure from 53.0% to 92.8%. The rate of performance of 5 not routinely recommended measures was 10.2% or less. Post-void residual and urinary flow measurement were optional measures, and were performed on 68.1% and 4.6% of new encounters respectively. Manual validation revealed the electronic medical record data extraction was concordant with manual review in 96.7% of cases (95% CI 94.8-98.5). Using electronic medical record based data extraction techniques, we reliably document a baseline adherence rate with AUA guidelines on the management of benign prostatic hyperplasia. Establishing this benchmark will be important for future investigation into patient outcomes related to guideline adherence and into methods for improving provider adherence. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Using an electronic prescribing system to ensure accurate medication lists in a large multidisciplinary medical group.

PubMed

Stock, Ron; Scott, Jim; Gurtel, Sharon

2009-05-01

Although medication safety has largely focused on reducing medication errors in hospitals, the scope of adverse drug events in the outpatient setting is immense. A fundamental problem occurs when a clinician lacks immediate access to an accurate list of the medications that a patient is taking. Since 2001, PeaceHealth Medical Group (PHMG), a multispecialty physician group, has been using an electronic prescribing system that includes medication-interaction warnings and allergy checks. Yet, most practitioners recognized the remaining potential for error, especially because there was no assurance regarding the accuracy of information on the electronic medical record (EMR)-generated medication list. PeaceHealth developed and implemented a standardized approach to (1) review and reconcile the medication list for every patient at each office visit and (2) report on the results obtained within the PHMG clinics. In 2005, PeaceHealth established the ambulatory medication reconciliation project to develop a reliable, efficient process for maintaining accurate patient medication lists. Each of PeaceHealth's five regions created a medication reconciliation task force to redesign its clinical practice, incorporating the systemwide aims and agreed-on key process components for every ambulatory visit. Implementation of the medication reconciliation process at the PHMG clinics resulted in a substantial increase in the number of accurate medication lists, with fewer discrepancies between what the patient is actually taking and what is recorded in the EMR. The PeaceHealth focus on patient safety, and particularly the reduction of medication errors, has involved a standardized approach for reviewing and reconciling medication lists for every patient visiting a physician office. The standardized processes can be replicated at other ambulatory clinics-whether or not electronic tools are available.

Data for free--can an electronic medical record provide outcome data for incontinence/prolapse repair procedures?

PubMed

Steidl, Matthew; Zimmern, Philippe

2013-01-01

We determined whether a custom computer program can improve the extraction and accuracy of key outcome measures from progress notes in an electronic medical record compared to a traditional data recording system for incontinence and prolapse repair procedures. Following institutional review board approval, progress notes were exported from the Epic electronic medical record system for outcome measure extraction by a custom computer program. The extracted data (D1) were compared against a manually maintained outcome measures database (D2). This work took place in 2 phases. During the first phase, volatile data such as questionnaires and standardized physical examination findings using the POP-Q (pelvic organ prolapse quantification) system were extracted from existing progress notes. The second phase used a progress note template incorporating key outcome measures to evaluate improvement in data accuracy and extraction rates. Phase 1 compared 6,625 individual outcome measures from 316 patients in D2 to 3,534 outcome measures extracted from progress notes in D1, resulting in an extraction rate of 53.3%. A subset of 3,763 outcome measures from D1 was created by excluding data that did not exist in the extraction, yielding an accuracy rate of 93.9%. With the use of the template in phase 2, the extraction rate improved to 91.9% (273 of 297) and the accuracy rate improved to 100% (273 of 273). In the field of incontinence and prolapse, the disciplined use of an electronic medical record template containing a preestablished set of key outcome measures can provide the ideal interface between required documentation and clinical research. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers.

PubMed

Frogner, Bianca K; Wu, Xiaoli; Park, Jeongyoung; Pittman, Patricia

2017-02-01

To assess how medical staffing mix changed over time in association with the adoption of electronic health records (EHRs) in community health centers (CHCs). Community health centers within the 50 states and Washington, DC. Estimated how the change in the share of total medical staff full-time equivalents (FTE) by provider category between 2007 and 2013 was associated with EHR adoption using fractional multinomial logit. 2007-2013 Uniform Data System, an administrative data set of Section 330 federal grant recipients; and Readiness for Meaningful Use and HIT and Patient Centered Medical Home Recognition Survey responses collected from Section 330 recipients between December 2010 and February 2011. Having an EHR system did significantly shift the share of workers over time between physicians and each of the other categories of health care workers. While an EHR system significantly shifted the share of physician and other medical staff, this effect did not significantly vary over time. CHCs with EHRs by the end of the study period had a relatively greater proportion of other medical staff compared to the proportion of physicians. Electronic health records appeared to influence staffing allocation in CHCs such that other medical staff may be used to support adoption of EHRs as well as be leveraged as an important care provider. © Health Research and Educational Trust.

Electronic Health Object

PubMed Central

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

Adverse Event extraction from Structured Product Labels using the Event-based Text-mining of Health Electronic Records (ETHER)system.

PubMed

Pandey, Abhishek; Kreimeyer, Kory; Foster, Matthew; Botsis, Taxiarchis; Dang, Oanh; Ly, Thomas; Wang, Wei; Forshee, Richard

2018-01-01

Structured Product Labels follow an XML-based document markup standard approved by the Health Level Seven organization and adopted by the US Food and Drug Administration as a mechanism for exchanging medical products information. Their current organization makes their secondary use rather challenging. We used the Side Effect Resource database and DailyMed to generate a comparison dataset of 1159 Structured Product Labels. We processed the Adverse Reaction section of these Structured Product Labels with the Event-based Text-mining of Health Electronic Records system and evaluated its ability to extract and encode Adverse Event terms to Medical Dictionary for Regulatory Activities Preferred Terms. A small sample of 100 labels was then selected for further analysis. Of the 100 labels, Event-based Text-mining of Health Electronic Records achieved a precision and recall of 81 percent and 92 percent, respectively. This study demonstrated Event-based Text-mining of Health Electronic Record's ability to extract and encode Adverse Event terms from Structured Product Labels which may potentially support multiple pharmacoepidemiological tasks.

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

PubMed

Kossman, Susan P; Scheidenhelm, Sandra L

2008-01-01

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

Electronic medical records and genomics (eMERGE) network exploration in cataract: Several new potential susceptibility loci

PubMed Central

Verma, Shefali S.; Hall, Molly A.; Goodloe, Robert J.; Berg, Richard L.; Carrell, Dave S.; Carlson, Christopher S.; Chen, Lin; Crosslin, David R.; Denny, Joshua C.; Jarvik, Gail; Li, Rongling; Linneman, James G.; Pathak, Jyoti; Peissig, Peggy; Rasmussen, Luke V.; Ramirez, Andrea H.; Wang, Xiaoming; Wilke, Russell A.; Wolf, Wendy A.; Torstenson, Eric S.; Turner, Stephen D.; McCarty, Catherine A.

2014-01-01

Purpose Cataract is the leading cause of blindness in the world, and in the United States accounts for approximately 60% of Medicare costs related to vision. The purpose of this study was to identify genetic markers for age-related cataract through a genome-wide association study (GWAS). Methods In the electronic medical records and genomics (eMERGE) network, we ran an electronic phenotyping algorithm on individuals in each of five sites with electronic medical records linked to DNA biobanks. We performed a GWAS using 530,101 SNPs from the Illumina 660W-Quad in a total of 7,397 individuals (5,503 cases and 1,894 controls). We also performed an age-at-diagnosis case-only analysis. Results We identified several statistically significant associations with age-related cataract (45 SNPs) as well as age at diagnosis (44 SNPs). The 45 SNPs associated with cataract at p<1×10−5 are in several interesting genes, including ALDOB, MAP3K1, and MEF2C. All have potential biologic relationships with cataracts. Conclusions This is the first genome-wide association study of age-related cataract, and several regions of interest have been identified. The eMERGE network has pioneered the exploration of genomic associations in biobanks linked to electronic health records, and this study is another example of the utility of such resources. Explorations of age-related cataract including validation and replication of the association results identified herein are needed in future studies. PMID:25352737

Trams, trains, planes and automobiles: logistics of conducting a statewide audit of medical records.

PubMed

Flood, Margaret; Pollock, Wendy; McDonald, Susan; Davey, Mary-Ann

2016-10-01

This paper reports on the logistics of conducting a validation study of a routinely collected dataset against medical records at hospitals to inform planning of similar studies. A stratified random sample of 15 hospitals and two homebirth practitioners was included. Site visits were arranged following consent. In addition to the validation of perinatal data, information was collected regarding logistics. Records at 14 metropolitan and rural hospitals up to 500 km from the research centre, and two homebirth practitioners, were audited. Obtaining consent to participate took between 5 days and 10 months. Auditors visited sites on 101 days, auditing 737 medical record pairs at 16 sites. Median audit time per record was 51.3 minutes; electronic records each took 36 minutes longer than paper. Travel time accounted for nearly one-quarter of audit time. Delays obtaining consents, long travel times and electronic records prolonged audit duration and expense. Employment of experts maximised use of available audit time. Conducting a validation study is a time-consuming and expensive exercise; however, confidence in the accuracy of public health data is vital. Validation studies are unquestionably important. Three alternative strategies have been proposed to make future studies viable. © 2016 Public Health Association of Australia.

Health Outcomes among Infants Born to Women Deployed to US Military Operations during Pregnancy

DTIC Science & Technology

2011-01-01

electronic inpa- tient and outpatient medical records from the following sources: Standard Inpatient Data Record, which contains one record for each...Deployment dates to military opera- tions between September 2001 and March 2008 were determined using military electronic data from the Defense... plasms requiring hospitalization in the first year of life among this cohort. Although multivariable statistical modeling was not performed for

Differing perspectives on parent access to their child's electronic medical record during neonatal intensive care hospitalization: a pilot study.

PubMed

Chung, Rebecca K; Kim, Una Olivia; Basir, Mir Abdul

2018-04-01

To improve informed medical decision-making, principles for family-centered neonatal care recommend that parents have access to their child's medical record on an ongoing basis during neonatal intensive unit care (NICU) hospitalization. Currently, many NICUs do not allow independent parent access to their child's electronic medical record (EMR) during hospitalization. We undertook a cross-sectional survey pilot study of medical professionals and parents to explore opinions regarding this practice. Inclusion criteria: 18-years old, English-literate, legal guardian of patients admitted to the NICU for 14 days. NICU medical professionals included physicians, nurse practitioners, nurses, and respiratory therapists. Medical professionals believed parent access would make their work more difficult, increase time documenting and updating families, making them more liable to litigation and hesitant to chart sensitive information. However, parents felt that they lacked control over their child's care and desired direct access to the EMR. Parents believed this would improve accuracy of their child's medical chart, and increase advocacy and understanding of their child's illness. NICU parents and medical professionals have differing perspectives on independent parental access to their child's EMR. More research is needed to explore the potential of independent parental EMR access to further improve family-centered neonatal care.

[Development of a medical equipment support information system based on PDF portable document].

PubMed

Cheng, Jiangbo; Wang, Weidong

2010-07-01

According to the organizational structure and management system of the hospital medical engineering support, integrate medical engineering support workflow to ensure the medical engineering data effectively, accurately and comprehensively collected and kept in electronic archives. Analyse workflow of the medical, equipment support work and record all work processes by the portable electronic document. Using XML middleware technology and SQL Server database, complete process management, data calculation, submission, storage and other functions. The practical application shows that the medical equipment support information system optimizes the existing work process, standardized and digital, automatic and efficient orderly and controllable. The medical equipment support information system based on portable electronic document can effectively optimize and improve hospital medical engineering support work, improve performance, reduce costs, and provide full and accurate digital data

Effect of electronic report writing on the quality of nursing report recording

PubMed Central

Heidarizadeh, Khadijeh; Rassouli, Maryam; Manoochehri, Houman; Tafreshi, Mansoureh Zagheri; Ghorbanpour, Reza Kashef

2017-01-01

Background and Aim Recording performed nursery actions is one of the main chores of nurses. The findings have shown that recorded reports are not qualitatively valid. Since electronic reports can be regarded as a base to write reports, this study aims at determining the effect of utilizing electronic nursing reports on the quality of the records. Methods This quasi-experimental study was conducted with the aim of applying an electronic system of nursing recording in the heart department of Shahid Rahimi Medical Center, Lorestan University of Medical Science. The samples were nursing reports on the hospitalized patients in the heart department, the basis of complete enumeration (census) during the fall of 2014. The subjects were sixteen employed nurses. To do the study, the software of nursing records was set based on the Clinical Care Classification system (CCC). The research’s tool was the checklist of the Standards of Nursing Documentation. Results The findings indicated that before and after the intervention, the amount of reports’ adaption with the written standards, respectively, was (21.8%) and (71.3%), and the most complete recording was medicine status (58%) and (100%). The worst complete recording before the intervention, acute changes was (99.1%) and nursing processes was (78%) and after, the medicine status, intake and output status and patient’s education (100%); while the nursing report structure was regarded in all cases (100%). The results showed that there is a significant difference in the quality of reporting before and after using CCC (p<0.001). Conclusions Since the necessary parameters for recording a standard report do exist in electronic reporting (CCC), from one point, nurses are reminded to record the necessary parts and from the other point, the system does not allow the user to shut it down unless the necessary parameters are recorded. For this reason, the quality of recorded reports with electronic reporting improves. PMID:29238481

Usability inspection to improve an electronic provincial medication repository.

PubMed

Kitson, Nicole A; Price, Morgan; Bowen, Michael; Lau, Francis

2013-01-01

Medication errors are a significant source of actual and potential harm for patients. Community medication records have the potential to reduce medication errors, but they can also introduce unintended consequences when there is low fit to task (low cognitive fit). PharmaNet is a provincially managed electronic repository that contains the records for community-based pharmacy-dispensed medications in British Columbia. This research explores the usability of PharmaNet, as a representative community-based medication repository. We completed usability inspections of PharmaNet through vendor applications. Vendor participants were asked to complete activity-driven scenarios, which highlighted aspects of medication management workflow. Screen recording was later reviewed. Heuristics were applied to explore usability issues and improvement opportunities. Usability inspection was conducted with four PharmaNet applications. Ninety-six usability issues were identified; half of these had potential implications for patient safety. These were primarily related to login and logout procedures; display of patient name; display of medications; update and display of alert information; and the changing or discontinuation of medications. PharmaNet was designed primarily to support medication dispensing and billing activities by community pharmacies, but is also used to support care providers with monitoring and prescribing activities. As such, some of the features do not have a strong fit for other clinical activities. To improve fit, we recommend: having a Current Medications List and Displaying Medication Utilization Charts.

Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice.

PubMed

Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

2003-01-01

It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center.

PubMed

Rizer, Milisa K; Kaufman, Beth; Sieck, Cynthia J; Hefner, Jennifer L; McAlearney, Ann Scheck

2015-01-01

Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation.

Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center

PubMed Central

Rizer, Milisa K.; Kaufman, Beth; Sieck, Cynthia J.; Hefner, Jennifer L.; McAlearney, Ann Scheck

2015-01-01

Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation. PMID:26396558

Real-time teleconsultation for difficult diseases with high resolution and large volume medical images in regional collaborative healthcare

NASA Astrophysics Data System (ADS)

Xie, Zhe; Sun, Jianyong; Yang, Yuanyuan; Gu, Yiping; Wang, Mingqing; Zhang, Jianguo

2018-03-01

Online peer to peer medical consultation between doctors such as physicians and specialists in China has a broad market demand and has been continuously accepted. For some difficult diseases, electronic medical records with medical images are required to present to both sides at same time during the consultation so that both sides can manipulate the records interactively to understand the medical meanings of the records, especially images. Here, we presented design of a teleconsultation system integrated with a cloud-based collaborative image sharing network to provide online peer-to-peer medical consultation for difficult cases with multi-media medical records including DICOM images. The presented teleconsultation system provides bidirectional interactive manipulations on images presented to peer-to-peer sides and has been used for small lung nodule diagnosis services between Huadong hospital in Shanghai and Jiaxing First Hospital in Zhejiang Province through Internet.

Citizens and personal health records - the case of Nelson Mandela Bay.

PubMed

Pottas, Dalenca; Mostert-Phipps, Nicky

2013-01-01

This paper explores citizen attitudes towards personal health records. The study was conducted in the Eastern Cape Province of South Africa. A cross-sectional design was used and structured questionnaires administered by data collectors. Most respondents (90%) believed it to be important to extremely important for their healthcare provider to have their complete medical records. Less than half of them (42%), however, believed that the healthcare provider did have their complete medical record available to them. Nevertheless, 69% do not keep a medical record as a way to address this concern. Most of them (84%) were not aware of the existence of electronic tools to capture a personal health record prior to participating in the survey. Concerns relating to the use of online PHRs were identified as privacy (58%), lack of time (27%) and a disinterest in computers (22%). It was found that the existence of a medical chronic condition is a strong predictor of keeping a medical record (albeit mostly in paper-based format).

Medication errors with electronic prescribing (eP): Two views of the same picture

PubMed Central

2010-01-01

Background Quantitative prospective methods are widely used to evaluate the impact of new technologies such as electronic prescribing (eP) on medication errors. However, they are labour-intensive and it is not always feasible to obtain pre-intervention data. Our objective was to compare the eP medication error picture obtained with retrospective quantitative and qualitative methods. Methods The study was carried out at one English district general hospital approximately two years after implementation of an integrated electronic prescribing, administration and records system. Quantitative: A structured retrospective analysis was carried out of clinical records and medication orders for 75 randomly selected patients admitted to three wards (medicine, surgery and paediatrics) six months after eP implementation. Qualitative: Eight doctors, 6 nurses, 8 pharmacy staff and 4 other staff at senior, middle and junior grades, and 19 adult patients on acute surgical and medical wards were interviewed. Staff interviews explored experiences of developing and working with the system; patient interviews focused on experiences of medicine prescribing and administration on the ward. Interview transcripts were searched systematically for accounts of medication incidents. A classification scheme was developed and applied to the errors identified in the records review. Results The two approaches produced similar pictures of the drug use process. Interviews identified types of error identified in the retrospective notes review plus two eP-specific errors which were not detected by record review. Interview data took less time to collect than record review, and provided rich data on the prescribing process, and reasons for delays or non-administration of medicines, including "once only" orders and "as required" medicines. Conclusions The qualitative approach provided more understanding of processes, and some insights into why medication errors can happen. The method is cost-effective and could be used to supplement information from anonymous error reporting schemes. PMID:20497532

Health Professionals' readiness to implement electronic medical record system at three hospitals in Ethiopia: a cross sectional study.

PubMed

Biruk, Senafekesh; Yilma, Tesfahun; Andualem, Mulusew; Tilahun, Binyam

2014-12-12

Electronic medical record systems are being implemented in many countries to support healthcare services. However, its adoption rate remains low, especially in developing countries due to technological, financial, and organizational factors. There is lack of solid evidence and empirical research regarding the pre implementation readiness of healthcare providers. The aim of this study is to assess health professionals' readiness and to identify factors that affect the acceptance and use of electronic medical recording system in the pre implementation phase at hospitals of North Gondar Zone, Ethiopia. An institution based cross-sectional quantitative study was conducted on 606 study participants from January to July 2013 at 3 hospitals in northwest Ethiopia. A pretested self-administered questionnaire was used to collect the required data. The data were entered using the Epi-Info version 3.5.1 software and analyzed using SPSS version 16 software. Descriptive statistics, bi-variate, and multi-variate logistic regression analyses were used to describe the study objectives and assess the determinants of health professionals' readiness for the system. Odds ratio at 95% CI was used to describe the association between the study and the outcome variables. Out of 606 study participants only 328 (54.1%) were found ready to use the electronic medical recording system according to our criteria assessment. The majority of the study participants, 432 (71.3%) and 331(54.6%) had good knowledge and attitude for EMR system, respectively. Gender (AOR = 1.87, 95% CI: [1.26, 2.78]), attitude (AOR = 1.56, 95% CI: [1.03, 2.49]), knowledge (AOR = 2.12, 95% CI: [1.32, 3.56]), and computer literacy (AOR =1.64, 95% CI: [0.99, 2.68]) were significantly associated with the readiness for EMR system. In this study, the overall health professionals' readiness for electronic medical record system and utilization was 54.1% and 46.5%, respectively. Gender, knowledge, attitude, and computer related skills were the determinants of the presence of a relatively low readiness and utilization of the system. Increasing awareness, knowledge, and skills of healthcare professionals on EMR system before system implementation is necessary to increase its adoption.

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

PubMed Central

Winkelman, Warren J.; Leonard, Kevin J.

2004-01-01

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

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

PubMed

Wass, Sofie; Vimarlund, Vivian; Ros, Axel

2017-04-01

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

Personal health records as portal to the electronic medical record.

PubMed

Cahill, Jennifer E; Gilbert, Mark R; Armstrong, Terri S

2014-03-01

This topic review discusses the evolving clinical challenges associated with the implementation of electronic personal health records (PHR) that are fully integrated with electronic medical records (EMR). The benefits of facilitating patient access to the EMR through web-based, PHR-portals may be substantial; foremost is the potential to enhance the flow of information between patient and healthcare practitioner. The benefits of improved communication and transparency of care are presumed to be a reduction in clinical errors, increased quality of care, better patient-management of disease, and better disease and symptom comprehension. Yet PHR databases allow patients open access to newly-acquired clinical data without the benefit of concurrent expert clinical interpretation, and therefore may create the potential for greater patient distress and uncertainty. With specific attention to neuro-oncology patients, this review focuses on the developing conflicts and consequences associated with the use of a PHR that parallels data acquisition of the EMR in real-time. We conclude with a discussion of recommendations for implementing fully-integrated PHR for neuro-oncology patients.

Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies

PubMed Central

Ravi, Sanjana

2014-01-01

Personal health records (PHRs), in contrast to electronic health records (EHRs) or electronic medical records (EMRs), are health records in which data are accessible to patients and not just providers. In recent years, many systems have enabled PHRs to be available in a mobile format. Mobile PHRs (mPHRs) allow patients to access health information via the Internet or telecommunication devices, such as mobile phones, personal digital assistants, and tablet computers. mPHRs have the potential to help patients and providers identify medical conditions and prescriptions from numerous locations, which may minimize medical errors and identify improvements to health behaviors during emergencies, when patients present to a new provider, or EHRs are not accessible. Despite their benefits, numerous challenges inhibit the adoption and further development of mPHRs, including integration into overall health technology infrastructure and legal and security concerns. This paper identifies the benefits of mPHRs during emergencies and the remaining challenges impeding full adoption and use, and provides recommendations to federal agencies to enhance support and use of mPHRs. PMID:25098942

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 design of knowledge-based systems, to assist the adoption process of electronic health records in an automatic fashion. From our review, six critical adoption factors have been identified: user attitude towards information systems, workflow impact, interoperability, technical support, communication among users, and expert support. The main limitation of the taxonomy is the different impact of the adoption factors of electronic health records reported by some studies depending on the type of practice, setting, or attention level; however, these features are a determinant aspect with regard to the adoption rate for the latter rather than the presence of a specific critical adoption factor. Conclusions The critical adoption factors established here provide a sound theoretical basis for research to understand, support, and facilitate the adoption of electronic health records to physicians in benefit of patients. PMID:20950458

Patients' consent preferences for research uses of information in electronic medical records: interview and survey data

PubMed Central

Willison, Donald J; Keshavjee, Karim; Nair, Kalpana; Goldsmith, Charlie; Holbrook, Anne M

2003-01-01

Objectives To assess patients' preferred method of consent for the use of information from electronic medical records for research. Design Interviews and a structured survey of patients in practices with electronic medical records. Setting Family practices in southern Ontario, Canada. Participants 123 patients: 17 were interviewed and 106 completed a survey. Main outcome measures Patients' opinions and concerns on use of information from their medical records for research and their preferences for method of consent. Results Most interviewees were willing to allow the use of their information for research purposes, although the majority preferred that consent was sought first. The seeking of consent was considered an important element of respect for the individual. Most interviewees made little distinction between identifiable and anonymised data. Research sponsored by private insurance firms generated the greatest concern, and research sponsored by foundation the least. Sponsorship by drug companies evoked negative responses during interview and positive responses in the survey. Conclusions Patients are willing to allow information from their medical records to be used for research, but most prefer to be asked for consent either verbally or in writing. What is already known on this topicLegislation is being introduced worldwide to restrict the circumstances under which personal information may be used for secondary purposes without consentLittle empirical information exists about patients' concerns over privacy and preferences for consent for use of such information for researchWhat this study addsPatients are willing to allow personal information to be used for research purposes but want to be actively consulted firstPatients make little distinction between identifiable and non-identifiable informationMost patients prefer a time limit for their consent PMID:12586673

Elimination of Emergency Department Medication Errors Due To Estimated Weights.

PubMed

Greenwalt, Mary; Griffen, David; Wilkerson, Jim

2017-01-01

From 7/2014 through 6/2015, 10 emergency department (ED) medication dosing errors were reported through the electronic incident reporting system of an urban academic medical center. Analysis of these medication errors identified inaccurate estimated weight on patients as the root cause. The goal of this project was to reduce weight-based dosing medication errors due to inaccurate estimated weights on patients presenting to the ED. Chart review revealed that 13.8% of estimated weights documented on admitted ED patients varied more than 10% from subsequent actual admission weights recorded. A random sample of 100 charts containing estimated weights revealed 2 previously unreported significant medication dosage errors (.02 significant error rate). Key improvements included removing barriers to weighing ED patients, storytelling to engage staff and change culture, and removal of the estimated weight documentation field from the ED electronic health record (EHR) forms. With these improvements estimated weights on ED patients, and the resulting medication errors, were eliminated.

Electronic Health Records: Overcoming Obstacles to Improve Acceptance and Utilization for Mental Health Clinicians

ERIC Educational Resources Information Center

Odom, Stephen A.

2017-01-01

The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have…

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…

Electronic medical record in cardiology: a 10-year Italian experience.

PubMed

Carpeggiani, Clara; Macerata, Alberto; Morales, Maria Aurora

2015-08-01

the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based. an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined. the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology. the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization.

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

PubMed

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

2005-08-01

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

Building clinical data groups for electronic medical record in China.

PubMed

Tu, Haibo; Yu, Yingtao; Yang, Peng; Tang, Xuejun; Hu, Jianping; Rao, Keqin; Pan, Feng; Xu, Yongyong; Liu, Danhong

2012-04-01

This article aims at building clinical data groups for Electronic Medical Records (EMR) in China. These data groups can be reused as basic information units in building the medical sheets of Electronic Medical Record Systems (EMRS) and serve as part of its implementation guideline. The results were based on medical sheets, the forms that are used in hospitals, which were collected from hospitals. To categorize the information in these sheets into data groups, we adopted the Health Level 7 Clinical Document Architecture Release 2 Model (HL7 CDA R2 Model). The regulations and legal documents concerning health informatics and related standards in China were implemented. A set of 75 data groups with 452 data elements was created. These data elements were atomic items that comprised the data groups. Medical sheet items contained clinical records information and could be described by standard data elements that exist in current health document protocols. These data groups match different units of the CDA model. Twelve data groups with 87 standardized data elements described EMR headers, and 63 data groups with 405 standardized data elements constituted the body. The later 63 data groups in fact formed the sections of the model. The data groups had two levels. Those at the first level contained both the second level data groups and the standardized data elements. The data groups were basically reusable information units that served as guidelines for building EMRS and that were used to rebuild a medical sheet and serve as templates for the clinical records. As a pilot study of health information standards in China, the development of EMR data groups combined international standards with Chinese national regulations and standards, and this was the most critical part of the research. The original medical sheets from hospitals contain first hand medical information, and some of their items reveal the data types characteristic of the Chinese socialist national health system. It is possible and critical to localize and stabilize the adopted international health standards through abstracting and categorizing those items for future sharing and for the implementation of EMRS in China.

The Role of Health Care Experience and Consumer Information Efficacy in Shaping Privacy and Security Perceptions of Medical Records: National Consumer Survey Results

PubMed Central

Beckjord, Ellen; Moser, Richard P; Hughes, Penelope; Hesse, Bradford W

2015-01-01

Background Providers’ adoption of electronic health records (EHRs) is increasing and consumers have expressed concerns about the potential effects of EHRs on privacy and security. Yet, we lack a comprehensive understanding regarding factors that affect individuals’ perceptions regarding the privacy and security of their medical information. Objective The aim of this study was to describe national perceptions regarding the privacy and security of medical records and identify a comprehensive set of factors associated with these perceptions. Methods Using a nationally representative 2011-2012 survey, we reported on adults’ perceptions regarding privacy and security of medical records and sharing of health information between providers, and whether adults withheld information from a health care provider due to privacy or security concerns. We used multivariable models to examine the association between these outcomes and sociodemographic characteristics, health and health care experience, information efficacy, and technology-related variables. Results Approximately one-quarter of American adults (weighted n=235,217,323; unweighted n=3959) indicated they were very confident (n=989) and approximately half indicated they were somewhat confident (n=1597) in the privacy of their medical records; we found similar results regarding adults’ confidence in the security of medical records (very confident: n=828; somewhat confident: n=1742). In all, 12.33% (520/3904) withheld information from a health care provider and 59.06% (2100/3459) expressed concerns about the security of both faxed and electronic health information. Adjusting for other characteristics, adults who reported higher quality of care had significantly greater confidence in the privacy and security of their medical records and were less likely to withhold information from their health care provider due to privacy or security concerns. Adults with higher information efficacy had significantly greater confidence in the privacy and security of medical records and less concern about sharing of health information by both fax and electronic means. Individuals’ perceptions of whether their providers use an EHR was not associated with any privacy or security outcomes. Conclusions Although most adults are confident in the privacy and security of their medical records, many express concerns regarding sharing of information between providers; a minority report withholding information from their providers due to privacy and security concerns. Whether individuals thought their provider was using an EHR was not associated with negative privacy/security perceptions or withholding, suggesting the transition to EHRs is not associated with negative perceptions regarding the privacy and security of medical information. However, monitoring to see how this evolves will be important. Given that positive health care experiences and higher information efficacy were associated with more favorable perceptions of privacy and security, efforts should continue to encourage providers to secure medical records, provide patients with a “meaningful choice” in how their data are shared, and enable individuals to access information they need to manage their care. PMID:25843686

The role of health care experience and consumer information efficacy in shaping privacy and security perceptions of medical records: national consumer survey results.

PubMed

Patel, Vaishali; Beckjord, Ellen; Moser, Richard P; Hughes, Penelope; Hesse, Bradford W

2015-04-02

Providers' adoption of electronic health records (EHRs) is increasing and consumers have expressed concerns about the potential effects of EHRs on privacy and security. Yet, we lack a comprehensive understanding regarding factors that affect individuals' perceptions regarding the privacy and security of their medical information. The aim of this study was to describe national perceptions regarding the privacy and security of medical records and identify a comprehensive set of factors associated with these perceptions. Using a nationally representative 2011-2012 survey, we reported on adults' perceptions regarding privacy and security of medical records and sharing of health information between providers, and whether adults withheld information from a health care provider due to privacy or security concerns. We used multivariable models to examine the association between these outcomes and sociodemographic characteristics, health and health care experience, information efficacy, and technology-related variables. Approximately one-quarter of American adults (weighted n=235,217,323; unweighted n=3959) indicated they were very confident (n=989) and approximately half indicated they were somewhat confident (n=1597) in the privacy of their medical records; we found similar results regarding adults' confidence in the security of medical records (very confident: n=828; somewhat confident: n=1742). In all, 12.33% (520/3904) withheld information from a health care provider and 59.06% (2100/3459) expressed concerns about the security of both faxed and electronic health information. Adjusting for other characteristics, adults who reported higher quality of care had significantly greater confidence in the privacy and security of their medical records and were less likely to withhold information from their health care provider due to privacy or security concerns. Adults with higher information efficacy had significantly greater confidence in the privacy and security of medical records and less concern about sharing of health information by both fax and electronic means. Individuals' perceptions of whether their providers use an EHR was not associated with any privacy or security outcomes. Although most adults are confident in the privacy and security of their medical records, many express concerns regarding sharing of information between providers; a minority report withholding information from their providers due to privacy and security concerns. Whether individuals thought their provider was using an EHR was not associated with negative privacy/security perceptions or withholding, suggesting the transition to EHRs is not associated with negative perceptions regarding the privacy and security of medical information. However, monitoring to see how this evolves will be important. Given that positive health care experiences and higher information efficacy were associated with more favorable perceptions of privacy and security, efforts should continue to encourage providers to secure medical records, provide patients with a "meaningful choice" in how their data are shared, and enable individuals to access information they need to manage their care.

Web technology for emergency medicine and secure transmission of electronic patient records.

PubMed

Halamka, J D

1998-01-01

The American Heritage dictionary defines the word "web" as "something intricately contrived, especially something that ensnares or entangles." The wealth of medical resources on the World Wide Web is now so extensive, yet disorganized and unmonitored, that such a definition seems fitting. In emergency medicine, for example, a field in which accurate and complete information, including patients' records, is urgently needed, more than 5000 Web pages are available today, whereas fewer than 50 were available in December 1994. Most sites are static Web pages using the Internet to publish textbook material, but new technology is extending the scope of the Internet to include online medical education and secure exchange of clinical information. This article lists some of the best Web sites for use in emergency medicine and then describes a project in which the Web is used for transmission and protection of electronic medical records.

Ubiquitous-Severance Hospital Project: Implementation and Results

PubMed Central

Chang, Bung-Chul; Kim, Young-A; Kim, Jee Hea; Jung, Hae Kyung; Kang, Eun Hae; Kang, Hee Suk; Lee, Hyung Il; Kim, Yong Ook; Yoo, Sun Kook; Sunwoo, Ilnam; An, Seo Yong; Jeong, Hye Jeong

2010-01-01

Objectives The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. Methods Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS) and expanding the knowledge base for research with a repository for clinical data and medical care information. Results The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. Conclusions YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identified. PMID:21818425

Comparison of Grouping Methods for Template Extraction from VA Medical Record Text.

PubMed

Redd, Andrew M; Gundlapalli, Adi V; Divita, Guy; Tran, Le-Thuy; Pettey, Warren B P; Samore, Matthew H

2017-01-01

We investigate options for grouping templates for the purpose of template identification and extraction from electronic medical records. We sampled a corpus of 1000 documents originating from Veterans Health Administration (VA) electronic medical record. We grouped documents through hashing and binning tokens (Hashed) as well as by the top 5% of tokens identified as important through the term frequency inverse document frequency metric (TF-IDF). We then compared the approaches on the number of groups with 3 or more and the resulting longest common subsequences (LCSs) common to all documents in the group. We found that the Hashed method had a higher success rate for finding LCSs, and longer LCSs than the TF-IDF method, however the TF-IDF approach found more groups than the Hashed and subsequently more long sequences, however the average length of LCSs were lower. In conclusion, each algorithm appears to have areas where it appears to be superior.

Ubiquitous-severance hospital project: implementation and results.

PubMed

Chang, Bung-Chul; Kim, Nam-Hyun; Kim, Young-A; Kim, Jee Hea; Jung, Hae Kyung; Kang, Eun Hae; Kang, Hee Suk; Lee, Hyung Il; Kim, Yong Ook; Yoo, Sun Kook; Sunwoo, Ilnam; An, Seo Yong; Jeong, Hye Jeong

2010-03-01

The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS) and expanding the knowledge base for research with a repository for clinical data and medical care information. The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identified.

Clinical Decision Support: Effectiveness in Improving Quality Processes and Clinical Outcomes and Factors That May Influence Success

PubMed Central

Murphy, Elizabeth V.

2014-01-01

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the “meaningful use” of electronic medical record systems. An important component of the “Meaningful Use” legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study. PMID:24910564

Coastal Pacific Doctor Associates: Implementation of a Purchased System

ERIC Educational Resources Information Center

Schwieger, Dana; McDonald, Michael

2015-01-01

Coastal Pacific Doctor Associates (CPDA) is a multi-physician medical practice located along the west coast. CPDA decided to replace their inadequate and outdated medical office system during a time of tremendous restructuring in the medical software industry. In their impatience, CPDA chose an electronic medical record (EMR) and practice…

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 their patients.

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

Ethics of medical records and professional communications.

PubMed

Recupero, Patricia R

2008-01-01

In child and adolescent psychiatry, medical records and professional communications raise important ethical concerns for the treating or consulting clinician. Although a distinction may be drawn between internal records (eg, medical records and psychotherapy notes) and external communications (eg, consultation reports and correspondence with pediatricians), several ethical principles apply to both types of documentation; however, specific considerations may vary, depending upon the context in which the records or communications were produced. Special care is due with regard to thoroughness and honesty, collaboration and cooperation, autonomy and dignity of the patient, confidentiality of the patient and family members, maintaining objectivity and neutrality, electronic communications media, and professional activities (eg, political advocacy). This article reviews relevant ethical concerns for child and adolescent psychiatrists with respect to medical records and professional communications, drawing heavily from forensic and legal sources, and offers additional recommendations for further reading for clarification and direction on ethical dilemmas.

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.

Removal of paper-based health records from Norwegian hospitals: effects on clinical workflow.

PubMed

Lium, Jan Tore; Faxvaag, Arild

2006-01-01

Several Norwegian hospitals have, plan, or are in the process of removing the paper-based health record from clinical workflow. To assess the impact on usage and satisfaction of electronic health record (EHR) systems, we conducted a survey among physicians, nurses and medical secretaries at selected departments from six Norwegian hospitals. The main feature of the questionnaire is the description of a set of tasks commonly performed at hospitals, and respondents were asked to rate their usage and change of ease compared to previous routines for each tasks. There were 24 tasks for physicians, 19 for nurses and 23 for medical secretaries. In total, 64 physicians, 128 nurses and 57 medical secretaries responded, corresponding to a response rate of 68%, 58% and 84% respectively. Results showed a large degree of use among medical secretaries, while physicians and nurses displayed a more modest degree of use. Possibly suggesting that the EHR systems among clinicians still is considered more of an administrative system. Among the two latter groups, tasks regarding information retrieval were used more extensively than tasks regarding generating and storing information. Also, we observed large differences between hospitals and higher satisfaction with the part of the system handling regular electronic data than scanned document images. Even though the increase in use among clinicians after removing the paper based record were mainly in tasks where respondents had no choice other than use the electronic health record, the attitude towards EHR-systems were mainly positive. Thus, while removing the paper based record has yet to promote new ways of working, we see it as an important step towards the EHR system of tomorrow. Several Norwegian hospitals have shown that it is possible.

The scope and direction of health informatics.

PubMed

McGinnis, Patrick J

2002-05-01

Health Informatics (HI) is a dynamic discipline based on the medical sciences, information sciences, and cognitive sciences. Its domain can broadly be defined as medical information management. The purpose of this paper is to provide an overview of this domain, discuss the current "state of the art," and indicate the likely growth areas for health informatics. The sources of information used in this paper are selected publications from the literature of Health Informatics, HI 5300: Introduction to Health Informatics, which is a course from the Department of Health Informatics at the University of Texas Houston Health Sciences Center, and the author's personal experience in practicing telemedicine and implementing an electronic medical record at the NASA-Johnson Space Center. The conclusion is that the direction of Health Informatics is in the direction of data management, transfer, and representation via electronic medical records and the Internet.

The scope and direction of health informatics

NASA Technical Reports Server (NTRS)

McGinnis, Patrick J.

2002-01-01

Health Informatics (HI) is a dynamic discipline based on the medical sciences, information sciences, and cognitive sciences. Its domain can broadly be defined as medical information management. The purpose of this paper is to provide an overview of this domain, discuss the current "state of the art," and indicate the likely growth areas for health informatics. The sources of information used in this paper are selected publications from the literature of Health Informatics, HI 5300: Introduction to Health Informatics, which is a course from the Department of Health Informatics at the University of Texas Houston Health Sciences Center, and the author's personal experience in practicing telemedicine and implementing an electronic medical record at the NASA-Johnson Space Center. The conclusion is that the direction of Health Informatics is in the direction of data management, transfer, and representation via electronic medical records and the Internet.

Enhanced Identification of Eligibility for Depression Research Using an Electronic Medical Record Search Engine

PubMed Central

Seyfried, Lisa; Hanauer, David; Nease, Donald; Albeiruti, Rashad; Kavanagh, Janet; Kales, Helen C.

2009-01-01

Purpose Electronic medical records (EMR) have become part of daily practice for many physicians. Attempts have been made to apply electronic search engine technology to speed EMR review. This was a prospective, observational study to compare the speed and accuracy of electronic search engine vs. manual review of the EMR. Methods Three raters reviewed 49 cases in the EMR to screen for eligibility in a depression study using the electronic search engine (EMERSE). One week later raters received a scrambled set of the same patients including 9 distractor cases, and used manual EMR review to determine eligibility. For both methods, accuracy was assessed for the original 49 cases by comparison with a gold standard rater. Results Use of EMERSE resulted in considerable time savings; chart reviews using EMERSE were significantly faster than traditional manual review (p=0.03). The percent agreement of raters with the gold standard (e.g. concurrent validity) using either EMERSE or manual review was not significantly different. Conclusions Using a search engine optimized for finding clinical information in the free-text sections of the EMR can provide significant time savings while preserving reliability. The major power of this search engine is not from a more advanced and sophisticated search algorithm, but rather from a user interface designed explicitly to help users search the entire medical record in a way that protects health information. PMID:19560962

Use of an electronic problem list by primary care providers and specialists.

PubMed

Wright, Adam; Feblowitz, Joshua; Maloney, Francine L; Henkin, Stanislav; Bates, David W

2012-08-01

Accurate patient problem lists are valuable tools for improving the quality of care, enabling clinical decision support, and facilitating research and quality measurement. However, problem lists are frequently inaccurate and out-of-date and use varies widely across providers. Our goal was to assess provider use of an electronic problem list and identify differences in usage between medical specialties. Chart review of a random sample of 100,000 patients who had received care in the past two years at a Boston-based academic medical center. Counts were collected of all notes and problems added for each patient from 1/1/2002 to 4/30/2010. For each entry, the recording provider and the clinic in which the entry was recorded was collected. We used the Healthcare Provider Taxonomy Code Set to categorize each clinic by specialty. We analyzed the problem list use across specialties, controlling for note volume as a proxy for visits. A total of 2,264,051 notes and 158,105 problems were recorded in the electronic medical record for this population during the study period. Primary care providers added 82.3% of all problems, despite writing only 40.4% of all notes. Of all patients, 49.1% had an assigned primary care provider (PCP) affiliated with the hospital; patients with a PCP had an average of 4.7 documented problems compared to 1.5 problems for patients without a PCP. Primary care providers were responsible for the majority of problem documentation; surgical and medical specialists and subspecialists recorded a disproportionately small number of problems on the problem list.

Implementation of electronic medical records

PubMed Central

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

2011-01-01

Abstract Objective To study the effect of electronic medical record (EMR) implementation on preventive services covered by Ontario’s pay-for-performance program. Design Prospective double-cohort study. Participants Twenty-seven community-based family physicians. Setting Toronto, Ont. Intervention Eighteen physicians implemented EMRs, while 9 physicians continued to use paper records. Main outcome measure Provision of 4 preventive services affected by pay-for-performance incentives (Papanicolaou tests, screening mammograms, fecal occult blood testing, and influenza vaccinations) in the first 2 years of EMR implementation. Results After adjustment, combined preventive services for the EMR group increased by 0.7%, a smaller increase than that seen in the non-EMR group (P = .55, 95% confidence interval −2.8 to 3.9). Conclusion When compared with paper records, EMR implementation had no significant effect on the provision of the 4 preventive services studied. PMID:21998246

Electronic health records and improved nursing management of chronic obstructive pulmonary disease.

PubMed

Liu, Fengping; Zou, Yeqing; Huang, Qingmei; Zheng, Li; Wang, Wei

2015-01-01

This paper identifies evolving trends in the diagnosis and treatment of chronic obstructive pulmonary disease (COPD), and recommends the integration of nursing strategies in COPD management via widespread implementation of electronic health records. COPD is a complex lung disease with diverse origins, both physical and behavioral, manifested in a wide range of symptoms that further increase the patient's risk for comorbidities. Early diagnosis and effective management of COPD require monitoring of a dizzying array of COPD symptoms over extended periods of time, and nurses are especially well positioned to manage potential progressions of COPD, as frontline health care providers who obtain, record, and organize patient data. Developments in medical technology greatly aid nursing management of COPD, from the deployment of spirometry as a diagnostic tool at the family practice level to newly approved treatment options, including non-nicotine pharmacotherapies that reduce the cravings associated with tobacco withdrawal. Among new medical technologies, electronic health records have proven particularly advantageous in the management of COPD, enabling providers to gather, maintain, and reference more patient data than has ever been possible before. Thus, consistent and widespread implementation of electronic health records facilitates the coordination of diverse treatment strategies, resulting in increased positive health outcomes for patients with COPD.

Learning a Health Knowledge Graph from Electronic Medical Records.

PubMed

Rotmensch, Maya; Halpern, Yoni; Tlimat, Abdulhakim; Horng, Steven; Sontag, David

2017-07-20

Demand for clinical decision support systems in medicine and self-diagnostic symptom checkers has substantially increased in recent years. Existing platforms rely on knowledge bases manually compiled through a labor-intensive process or automatically derived using simple pairwise statistics. This study explored an automated process to learn high quality knowledge bases linking diseases and symptoms directly from electronic medical records. Medical concepts were extracted from 273,174 de-identified patient records and maximum likelihood estimation of three probabilistic models was used to automatically construct knowledge graphs: logistic regression, naive Bayes classifier and a Bayesian network using noisy OR gates. A graph of disease-symptom relationships was elicited from the learned parameters and the constructed knowledge graphs were evaluated and validated, with permission, against Google's manually-constructed knowledge graph and against expert physician opinions. Our study shows that direct and automated construction of high quality health knowledge graphs from medical records using rudimentary concept extraction is feasible. The noisy OR model produces a high quality knowledge graph reaching precision of 0.85 for a recall of 0.6 in the clinical evaluation. Noisy OR significantly outperforms all tested models across evaluation frameworks (p < 0.01).

Aspects of privacy for electronic health records.

PubMed

Haas, Sebastian; Wohlgemuth, Sven; Echizen, Isao; Sonehara, Noboru; Müller, Günter

2011-02-01

Patients' medical data have been originally generated and maintained by health professionals in several independent electronic health records (EHRs). Centralized electronic health records accumulate medical data of patients to improve their availability and completeness; EHRs are not tied to a single medical institution anymore. Nowadays enterprises with the capacity and knowledge to maintain this kind of databases offer the services of maintaining EHRs and adding personal health data by the patients. These enterprises get access on the patients' medical data and act as a main point for collecting and disclosing personal data to third parties, e.g. among others doctors, healthcare service providers and drug stores. Existing systems like Microsoft HealthVault and Google Health comply with data protection acts by letting the patients decide on the usage and disclosure of their data. But they fail in satisfying essential requirements to privacy. We propose a privacy-protecting information system for controlled disclosure of personal data to third parties. Firstly, patients should be able to express and enforce obligations regarding a disclosure of health data to third parties. Secondly, an organization providing EHRs should neither be able to gain access to these health data nor establish a profile about patients. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Considerations for choosing an electronic medical record for an ophthalmology practice.

PubMed

DeBry, P W

2001-04-01

To give a brief overview of issues pertinent to selecting an ophthalmic electronic medical record (EMR) program and to outline the company demographics and software capabilities of the major vendors in this area. Software companies shipping an EMR package were contacted to obtain information on their software and company demographics. The focus was on companies selectively marketing to ophthalmology practices, and, therefore, most were selected based on their representation at the 1998 and/or 1999 American Academy of Ophthalmology meeting. Software companies that responded to repeated inquiries in a timely fashion were included. Sixteen companies were evaluated. Electronic medical records packages ranged from $3000 to $80 000 (mean, approximately $30 000). Company demographics revealed a range from 1 to 1600 employees (mean, 204). Most of these companies have been in business for 6 years or less (range, 1-15 years; mean, 6 years). My opinions concerning various aspects of the EMR are presented. There is a wide range of EMR products available for the ophthalmology practice. Computer technology has matured to a point at which the graphical demands of the ophthalmology EMR can be satisfied. Weaknesses do exist in the inherent difficulty of recording an ophthalmology encounter, the relative adolescence of software companies, and the lack of standards in the industry.

Electronic health record tools' support of nurses' clinical judgment and team communication.

PubMed

Kossman, Susan P; Bonney, Leigh Ann; Kim, Myoung Jin

2013-11-01

Nurses need to quickly process information to form clinical judgments, communicate with the healthcare team, and guide optimal patient care. Electronic health records not only offer potential for enhanced care but also introduce unintended consequences through changes in workflow, clinical judgment, and communication. We investigated nurses' use of improvised (self-made) and electronic health record-generated cognitive artifacts on clinical judgment and team communication. Tanner's Clinical Judgment Model provided a framework and basis for questions in an online survey and focus group interviews. Findings indicated that (1) nurses rated self-made work lists and medication administration records highest for both clinical judgment and communication, (2) tools aided different dimensions of clinical judgment, and (3) interdisciplinary tools enhance team communication. Implications are that electronic health record tool redesign could better support nursing work.

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

PubMed

Chiang, Michael F; Starren, Justin B

2002-01-01

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

Hospitals prepare plans, drill staff to ensure that potential Ebola patients are identified, isolated, and managed safely.

PubMed

2014-12-01

Hospitals around the country have stepped up their efforts to train staff and implement procedures to ensure the safe identification and management of any patients with signs of Ebola virus disease (EVD). Ronald Reagan UCLA Medical Center in Los Angeles, CA, held an "Ebola preparedness exercise" to give staff an opportunity to walk through the hospital's protocol for handling a simulated patient with EVD. The University of Alabama at Birmingham (UAB) Medical Center has held similar exercises, and is now holding twice-weekly meetings of its leadership team to make sure that all new developments in the Ebola outbreak are communicated. UCLA Medical Center has prepared PPE kits based on the practices developed at Emory University Hospital, which has thus far had the most experience in this country in caring for patients with EVD. The UCLA Health System has adjusted its medical record system so that a red flag is placed on the electronic medical record [EMR] of any patient who has recently traveled to a high-risk area. UAB Medical Center has incorporated what had been a paper-and-pencil screening tool for EVD into its electronic medical record. Training on PPE as well as EVD screening is being provided to first-responders and 911 call center dispatchers in the UAB system.

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…

Validating the Technology Acceptance Model in the Context of the Laboratory Information System-Electronic Health Record Interface System

ERIC Educational Resources Information Center

Aquino, Cesar A.

2014-01-01

This study represents a research validating the efficacy of Davis' Technology Acceptance Model (TAM) by pairing it with the Organizational Change Readiness Theory (OCRT) to develop another extension to the TAM, using the medical Laboratory Information Systems (LIS)--Electronic Health Records (EHR) interface as the medium. The TAM posits that it is…

IT-CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety.

PubMed

Caron, Alexandre; Chazard, Emmanuel; Muller, Joris; Perichon, Renaud; Ferret, Laurie; Koutkias, Vassilis; Beuscart, Régis; Beuscart, Jean-Baptiste; Ficheur, Grégoire

2017-03-01

The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety. To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases. We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement. IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data. IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool's usability must be evaluated and improved in further research. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Medical Student Documentation in the Electronic Medical Record: Patterns of Use and Barriers.

PubMed

Wittels, Kathleen; Wallenstein, Joshua; Patwari, Rahul; Patel, Sundip

2017-01-01

Electronic health records (EHR) have become ubiquitous in emergency departments. Medical students rotating on emergency medicine (EM) clerkships at these sites have constant exposure to EHRs as they learn essential skills. The Association of American Medical Colleges (AAMC), the Liaison Committee on Medical Education (LCME), and the Alliance for Clinical Education (ACE) have determined that documentation of the patient encounter in the medical record is an essential skill that all medical students must learn. However, little is known about the current practices or perceived barriers to student documentation in EHRs on EM clerkships. We performed a cross-sectional study of EM clerkship directors at United States medical schools between March and May 2016. A 13-question IRB-approved electronic survey on student documentation was sent to all EM clerkship directors. Only one response from each institution was permitted. We received survey responses from 100 institutions, yielding a response rate of 86%. Currently, 63% of EM clerkships allow medical students to document a patient encounter in the EHR. The most common reasons cited for not permitting students to document a patient encounter were hospital or medical school rule forbidding student documentation (80%), concern for medical liability (60%), and inability of student notes to support medical billing (53%). Almost 95% of respondents provided feedback on student documentation with supervising faculty being the most common group to deliver feedback (92%), followed by residents (64%). Close to two-thirds of medical students are allowed to document in the EHR on EM clerkships. While this number is robust, many organizations such as the AAMC and ACE have issued statements and guidelines that would look to increase this number even further to ensure that students are prepared for residency as well as their future careers. Almost all EM clerkships provided feedback on student documentation indicating the importance for students to learn this skill.

How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data.

PubMed

Pisa, Federica Edith; Palese, Francesca; Romanese, Federico; Barbone, Fabio; Logroscino, Giancarlo; Riedel, Oliver

2018-06-05

Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used. Copyright © 2018 John Wiley & Sons, Ltd.

Development of a standardized Intranet database of formulation records for nonsterile compounding, Part 2.

PubMed

Haile, Michael; Anderson, Kim; Evans, Alex; Crawford, Angela

2012-01-01

In part 1 of this series, we outlined the rationale behind the development of a centralized electronic database used to maintain nonsterile compounding formulation records in the Mission Health System, which is a union of several independent hospitals and satellite and regional pharmacies that form the cornerstone of advanced medical care in several areas of western North Carolina. Hospital providers in many healthcare systems require compounded formulations to meet the needs of their patients (in particular, pediatric patients). Before a centralized electronic compounding database was implemented in the Mission Health System, each satellite or regional pharmacy affiliated with that system had a specific set of formulation records, but no standardized format for those records existed. In this article, we describe the quality control, database platform selection, description, implementation, and execution of our intranet database system, which is designed to maintain, manage, and disseminate nonsterile compounding formulation records in the hospitals and affiliated pharmacies of the Mission Health System. The objectives of that project were to standardize nonsterile compounding formulation records, create a centralized computerized database that would increase healthcare staff members' access to formulation records, establish beyond-use dates based on published stability studies, improve quality control, reduce the potential for medication errors related to compounding medications, and (ultimately) improve patient safety.

The completeness of electronic medical record data for patients with Type 2 Diabetes in primary care and its implications for computer modelling of predicted clinical outcomes.

PubMed

Staff, Michael; Roberts, Christopher; March, Lyn

2016-10-01

To describe the completeness of routinely collected primary care data that could be used by computer models to predict clinical outcomes among patients with Type 2 Diabetes (T2D). Data on blood pressure, weight, total cholesterol, HDL-cholesterol and glycated haemoglobin levels for regular patients were electronically extracted from the medical record software of 12 primary care practices in Australia for the period 2000-2012. The data was analysed for temporal trends and for associations between patient characteristics and completeness. General practitioners were surveyed to identify barriers to recording data and strategies to improve its completeness. Over the study period data completeness improved up to around 80% complete although the recording of weight remained poorer at 55%. T2D patients with Ischaemic Heart Disease were more likely to have their blood pressure recorded (OR 1.6, p=0.02). Practitioners reported not experiencing any major barriers to using their computer medical record system but did agree with some suggested strategies to improve record completeness. The completeness of routinely collected data suitable for input into computerised predictive models is improving although other dimensions of data quality need to be addressed. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

A Java-based electronic healthcare record software for beta-thalassaemia.

PubMed

Deftereos, S; Lambrinoudakis, C; Andriopoulos, P; Farmakis, D; Aessopos, A

2001-01-01

Beta-thalassaemia is a hereditary disease, the prevalence of which is high in persons of Mediterranean, African, and Southeast Asian ancestry. In Greece it constitutes an important public health problem. Beta-thalassaemia necessitates continuous and complicated health care procedures such as daily chelation; biweekly transfusions; and periodic cardiology, endocrinology, and hepatology evaluations. Typically, different care items are offered in different, often-distant, health care units, which leads to increased patient mobility. This is especially true in rural areas. Medical records of patients suffering from beta-thalassaemia are inevitably complex and grow in size very fast. They are currently paper-based, scattered over all units involved in the care process. This hinders communication of information between health care professionals and makes processing of the medical records difficult, thus impeding medical research. Our objective is to provide an electronic means for recording, communicating, and processing all data produced in the context of the care process of patients suffering from beta-thalassaemia. We have developed - and we present in this paper - Java-based Electronic Healthcare Record (EHCR) software, called JAnaemia. JAnaemia is a general-purpose EHCR application, which can be customized for use in all medical specialties. Customization for beta-thalassaemia has been performed in collaboration with 4 Greek hospitals. To be capable of coping with patient record diversity, JAnaemia has been based on the EHCR architecture proposed in the ENV 13606:1999 standard, published by the CEN/TC251 committee. Compliance with the CEN architecture also ensures that several additional requirements are fulfilled in relation to clinical comprehensiveness; to record sharing and communication; and to ethical, medico-legal, and computational issues. Special care has been taken to provide a user-friendly, form-based interface for data entry and processing. The experience gained through the use of JAnaemia in 4 Greek hospitals reveals a significant contribution towards (1) improvement of the quality of the data being recorded, since data entry is guided by appropriate forms, (2) easier cooperation between physicians, who share a common information repository, and (3) increased processing capabilities, which facilitate medical research. JAnaemia appears to be a useful tool, which can improve the quality of care offered to beta-thalassaemic patients in Greece.

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

PubMed

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

2014-09-01

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

A survey aimed at general citizens of the US and Japan about their attitudes toward electronic medical data handling.

PubMed

Kimura, Michio; Nakaya, Jun; Watanabe, Hiroshi; Shimizu, Toshiro; Nakayasu, Kazuyuki

2014-04-25

To clarify the views of the general population of two countries (US and Japan), concerning the handling of their medical records electronically. We contacted people nationwide in the United States at random via Random Digit Dialing (RDD) to obtain 200 eligible responders. The questionnaire was for obtaining the information on their attitudes towards handling of their medical records, disclosure of the name of disease, secondary usage of information, compiling their records into a lifelong medical record, and access to their medical records on the Internet. We had also surveyed people of Shizuoka prefecture in Japan using same questionnaires sent by mail, for which we obtained 457 valid answers. Even in an unidentifiable manner, US people feel profit-oriented usage of medical data without specific consent is not acceptable. There is a significant difference between usage of unidentifiable medical data for profit (about 50% feel negatively) and for official/research purposes (about 30% feel negatively). About 60% of the US responders have a negative view on the proposal that unidentifiable medical information be utilized for profit by private companies to attain healthcare cost savings. As regards compiling a lifelong medical record, positive answers and negative answers are almost equally divided in the US (46% vs. 38%) while more positive attitudes are seen in Japan (74% vs. 12%). However, any incentive measures aimed at changing attitudes to such a compiling including the discount of healthcare costs or insurance fees are unwelcomed by people regardless of their age or health condition in both surveys. Regarding the access to their own medical record via the Internet, 38% of the US responders feel this is unacceptable while 50.5% were willing to accept it. Participants from the US think that the extent of the sharing their identifiable medical records should be limited to the doctors-in-charge and specified doctors referred to by their own doctors. On the other hand, Japanese people find it acceptable for doctors of the same hospital to share their medical records. Even in unidentifiable manner, people in both countries think the profits resulting from the secondary use of medical records should be returned to the public or patients. With regard to compiling a lifelong medical record, participants from the US provided both positive answers and negative answers, while more positive attitudes were observed in Japan. However, any incentives or measures aimed at changing attitudes towards such a compilation, including provision of a discount on healthcare costs or insurance fees, were not welcomed by participants from US as well as those from Japan, regardless of their age or health condition.

SU-F-T-234: Quality Improvements in the Electronic Medical Record of Patients Treated with High Dose-Rate Brachytherapy

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

Diener, T; Wilkinson, D

Purpose: To improve workflow efficiency and patient safety by assessing the quality control documentation for HDR brachytherapy within our Electronic Medical Record System (Mosaiq). Methods: A list of parameters based on NRC regulations, our quality management program (QMP), recommendations of the ACR and the American Brachytherapy Society, and HDR treatment planning risks identified in our previous FMEA study was made. Next, the parameter entries were classified according to the type of data input—manual, electronic, or both. Manual entry included the electronic Brachytherapy Treatment Record (BTR) and pre-treatment Mosaiq Assessments list. Oncentra Treatment Reports (OTR) from the Oncentra Treatment Control Systemmore » constituted the electronic data. The OTR includes a Pre-treatment Report for each fraction, and a Treatment Summary Report at the completion of treatment. Each entry was then examined for appropriateness and completeness of data; adjustments and additions as necessary were then made. Results: Ten out of twenty-one recorded treatment parameters were identified to be documented within both the BTR and OTR. Of these ten redundancies, eight were changed from recorded values to a simple checklist in the BTR to avoid recording errors. The other redundancies were kept in both documents due to their value to ensuring patient safety. An edit was made to the current BTR quality assessment; this change revises the definition of a medical event in accordance with ODH Regulation 3701:1-58-101. One addition was made to the current QMP documents regarding HDR. This addition requires a physician to be present through the duration of HDR treatment in accordance with ODH Regulation 3701:1-58-59; Paragraph (F); Section (2); Subsection (a). Conclusion: Careful examination of HDR documentation that originates from different sources can help to improve the accuracy and reliability of the documents. In addition, there may be a small improvement in efficiency due to elimination of unnecessary redundancies.« less

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

PubMed

De Clercq, Etienne

2008-09-01

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

Considering Governance for Patient Access to E-Medical Records.

PubMed

Day, Karen; Wells, Susan

2015-01-01

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

An integrated multimedia medical information network system.

PubMed

Yamamoto, K; Makino, J; Sasagawa, N; Nagira, M

1998-01-01

An integrated multimedia medical information network system at Shimane Medical university has been developed to organize medical information generated from each section and provide information services useful for education, research and clinical practice. The report describes the outline of our system. It is designed to serve as a distributed database for electronic medical records and images. We are developing the MML engine that is to be linked to the world wide web (WWW) network system. To the users, this system will present an integrated multimedia representation of the patient records, providing access to both the image and text-based data required for an effective clinical decision making and medical education.

Using Informatics and the Electronic Medical Record to Describe Antimicrobial Use in the Clinical Management of Diarrhea Cases at 12 Companion Animal Practices

PubMed Central

Anholt, R. Michele; Berezowski, John; Ribble, Carl S.; Russell, Margaret L.; Stephen, Craig

2014-01-01

Antimicrobial drugs may be used to treat diarrheal illness in companion animals. It is important to monitor antimicrobial use to better understand trends and patterns in antimicrobial resistance. There is no monitoring of antimicrobial use in companion animals in Canada. To explore how the use of electronic medical records could contribute to the ongoing, systematic collection of antimicrobial use data in companion animals, anonymized electronic medical records were extracted from 12 participating companion animal practices and warehoused at the University of Calgary. We used the pre-diagnostic, clinical features of diarrhea as the case definition in this study. Using text-mining technologies, cases of diarrhea were described by each of the following variables: diagnostic laboratory tests performed, the etiological diagnosis and antimicrobial therapies. The ability of the text miner to accurately describe the cases for each of the variables was evaluated. It could not reliably classify cases in terms of diagnostic tests or etiological diagnosis; a manual review of a random sample of 500 diarrhea cases determined that 88/500 (17.6%) of the target cases underwent diagnostic testing of which 36/88 (40.9%) had an etiological diagnosis. Text mining, compared to a human reviewer, could accurately identify cases that had been treated with antimicrobials with high sensitivity (92%, 95% confidence interval, 88.1%–95.4%) and specificity (85%, 95% confidence interval, 80.2%–89.1%). Overall, 7400/15,928 (46.5%) of pets presenting with diarrhea were treated with antimicrobials. Some temporal trends and patterns of the antimicrobial use are described. The results from this study suggest that informatics and the electronic medical records could be useful for monitoring trends in antimicrobial use. PMID:25057893

Using informatics and the electronic medical record to describe antimicrobial use in the clinical management of diarrhea cases at 12 companion animal practices.

PubMed

Anholt, R Michele; Berezowski, John; Ribble, Carl S; Russell, Margaret L; Stephen, Craig

2014-01-01

Antimicrobial drugs may be used to treat diarrheal illness in companion animals. It is important to monitor antimicrobial use to better understand trends and patterns in antimicrobial resistance. There is no monitoring of antimicrobial use in companion animals in Canada. To explore how the use of electronic medical records could contribute to the ongoing, systematic collection of antimicrobial use data in companion animals, anonymized electronic medical records were extracted from 12 participating companion animal practices and warehoused at the University of Calgary. We used the pre-diagnostic, clinical features of diarrhea as the case definition in this study. Using text-mining technologies, cases of diarrhea were described by each of the following variables: diagnostic laboratory tests performed, the etiological diagnosis and antimicrobial therapies. The ability of the text miner to accurately describe the cases for each of the variables was evaluated. It could not reliably classify cases in terms of diagnostic tests or etiological diagnosis; a manual review of a random sample of 500 diarrhea cases determined that 88/500 (17.6%) of the target cases underwent diagnostic testing of which 36/88 (40.9%) had an etiological diagnosis. Text mining, compared to a human reviewer, could accurately identify cases that had been treated with antimicrobials with high sensitivity (92%, 95% confidence interval, 88.1%-95.4%) and specificity (85%, 95% confidence interval, 80.2%-89.1%). Overall, 7400/15,928 (46.5%) of pets presenting with diarrhea were treated with antimicrobials. Some temporal trends and patterns of the antimicrobial use are described. The results from this study suggest that informatics and the electronic medical records could be useful for monitoring trends in antimicrobial use.

Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data.

PubMed

Widdifield, Jessica; Bernatsky, Sasha; Thorne, J Carter; Bombardier, Claire; Jaakkimainen, R Liisa; Wing, Laura; Paterson, J Michael; Ivers, Noah; Butt, Debra; Lyddiatt, Anne; Hofstetter, Catherine; Ahluwalia, Vandana; Tu, Karen

2016-01-01

The Wait Time Alliance recently established wait time benchmarks for rheumatology consultations in Canada. Our aim was to quantify wait times to primary and rheumatology care for patients with rheumatic diseases. We identified patients from primary care practices in the Electronic Medical Record Administrative data Linked Database who had referrals to Ontario rheumatologists over the period 2000-2013. To assess the full care pathway, we identified dates of symptom onset, presentation in primary care and referral from electronic medical records. Dates of rheumatologist consultations were obtained by linking with physician service claims. We determined the duration of each phase of the care pathway (symptom onset to primary care encounter, primary care encounter to referral, and referral to rheumatologist consultation) and compared them with established benchmarks. Among 2430 referrals from 168 family physicians, 2015 patients (82.9%) were seen by 146 rheumatologists within 1 year of referral. Of the 2430 referrals, 2417 (99.5%) occurred between 2005 and 2013. The main reasons for referral were osteoarthritis (32.4%) and systemic inflammatory rheumatic diseases (30.6%). Wait times varied by diagnosis and geographic region. Overall, the median wait time from referral to rheumatologist consultation was 74 (interquartile range 27-101) days; it was 66 (interquartile range 18-84) days for systemic inflammatory rheumatic diseases. Wait time benchmarks were not achieved, even for the most urgent types of referral. For systemic inflammatory rheumatic diseases, most of the delays occurred before referral. Rheumatology wait times exceeded established benchmarks. Targeted efforts are needed to promote more timely access to both primary and rheumatology care. Routine linkage of electronic medical records with administrative data may help fill important gaps in knowledge about waits to primary and specialty care.

Standardized exchange of clinical documents--towards a shared care paradigm in glaucoma treatment.

PubMed

Gerdsen, F; Müller, S; Jablonski, S; Prokosch, H-U

2006-01-01

The exchange of medical data from research and clinical routine across institutional borders is essential to establish an integrated healthcare platform. In this project we want to realize the standardized exchange of medical data between different healthcare institutions to implement an integrated and interoperable information system supporting clinical treatment and research of glaucoma. The central point of our concept is a standardized communication model based on the Clinical Document Architecture (CDA). Further, a communication concept between different health care institutions applying the developed document model has been defined. With our project we have been able to prove that standardized communication between an Electronic Medical Record (EMR), an Electronic Health Record (EHR) and the Erlanger Glaucoma Register (EGR) based on the established conceptual models, which rely on CDA rel.1 level 1 and SCIPHOX, could be implemented. The HL7-tool-based deduction of a suitable CDA rel.2 compliant schema showed significant differences when compared with the manually created schema. Finally fundamental requirements, which have to be implemented for an integrated health care platform, have been identified. An interoperable information system can enhance both clinical treatment and research projects. By automatically transferring screening findings from a glaucoma research project to the electronic medical record of our ophthalmology clinic, clinicians could benefit from the availability of a longitudinal patient record. The CDA as a standard for exchanging clinical documents has demonstrated its potential to enhance interoperability within a future shared care paradigm.

Description of a Mobile-based Electronic Informed Consent System Development.

PubMed

Hwang, Min-A; Kwak, In Ja

2015-01-01

Seoul National University Hospital constructed and implemented a computer-based informed consent system in December 2011. As of 2013, 30% of the informed consents were still filled out manually on paper. Patients and medical staff continuously suggested the implementation of a system for electronic informed consent using portable devices. Therefore, a mobile-based system for electronic informed consent was developed in 2013 to prevent the issues that arise with computer-based systems and paper informed consent. The rate of filling out electronic informed consent increased from 69% to 95% following the implementation of the mobile-based electronic informed consent. This construction of a mobile-based electronic informed consent system would be a good reference point for the development of a mobile-based Electronic Medical Record and for various mobile system environments in medical institutions.

MEDRIS: The Problem Oriented Electronic Medical Record in Medical Education

PubMed Central

Rifat, Sami F.; Robert, Shanthi; Trace, David; Prakash, Sanjeev; Naeymi-Rad, Frank; Barnett, David; Pannicia, Gregory; Hammergren, David; Carmony, Lowell; Evens, Martha

1990-01-01

MEDRIS (The Medical Record Interface System) is an object oriented HyperCard interface designed to help physicians enter patient information as comfortably and naturally as possible. It can function as a stand alone system producing its own reports or serve as an interface to a medical expert system (e.g., MEDAS). MEDRIS plays an important role in the clinical education of medical students at the Chicago Medical School. MEDRIS portrays an intuitive, graphically oriented system that will provide a learning environment for the problem oriented medical record (POMR) that forms the basis of the structure of the history and physical exam. The enthusiasm shown by the medical students for this project has garnered support for including MEDRIS in the curriculum of the Introduction to Clinical Medicine course this semester. MEDRIS, developed using HyperCard, can be used as a tool not only for teaching POMR and physical diagnosis, but also computer literacy.

Patient-Perceived Usefulness of Online Electronic Medical Records: Employing Grounded Theory in the Development of Information and Communication Technologies for Use by Patients Living with Chronic Illness

PubMed Central

Winkelman, Warren J.; Leonard, Kevin J.; Rossos, Peter G.

2005-01-01

Objective: Patient use of online electronic medical records (EMR) holds the potential to improve health outcomes. The purpose of this study is to discover how patients living with chronic inflammatory bowel disease (IBD) value Internet-based patient access to electronic patient records. Design: This was a qualitative, exploratory, descriptive study using in-depth interviews and focus groups of a total of 12 patients with IBD of at least one-year duration at University Health Network, a tertiary care center in Toronto, Ontario. Results: Four themes have been elucidated that comprise a theoretical framework of patient-perceived information and communication technology usefulness: promotion of a sense of illness ownership, of patient-driven communication, of personalized support, and of mutual trust. Conclusions: For patients with chronic IBD, simply providing access to electronic medical records has little usefulness on its own. Useful technology for patients with IBD is multifaceted, self-care promoting, and integrated into the patient's already existing health and psychosocial support infrastructure. The four identified themes can serve as focal points for the evaluation of information technology designed for patient use, thus providing a patient-centered framework for developers seeking to adapt existing EMR systems to patient access and use for the purposes of improving health care quality and health outcomes. Further studies in other populations are needed to enhance generalizability of the emergent theory. PMID:15684128

Electronic Documentation Support Tools and Text Duplication in the Electronic Medical Record

ERIC Educational Resources Information Center

Wrenn, Jesse

2010-01-01

In order to ease the burden of electronic note entry on physicians, electronic documentation support tools have been developed to assist in note authoring. There is little evidence of the effects of these tools on attributes of clinical documentation, including document quality. Furthermore, the resultant abundance of duplicated text and…

Antidepressant medication use for primary care patients with and without medical comorbidities: a national electronic health record (EHR) network study.

PubMed

Gill, James M; Klinkman, Michael S; Chen, Ying Xia

2010-01-01

Because comorbid depression can complicate medical conditions (eg, diabetes), physicians may treat depression more aggressively in patients who have these conditions. This study examined whether primary care physicians prescribe antidepressant medications more often and in higher doses for persons with medical comorbidities. This secondary data analysis of electronic health record data was conducted in the Centricity Health Care User Research Network (CHURN), a national network of ambulatory practices that use a common outpatient electronic health record. Participants included 209 family medicine and general internal medicine providers in 40 primary care CHURN offices in 17 US states. Patients included adults with a new episode of depression that had been diagnosed during the period October 2006 through July 2007 (n = 1513). Prescription of antidepressant medication and doses of antidepressant medication were compared for patients with and without 6 comorbid conditions: diabetes, coronary heart disease, congestive heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, and cancer. 20.7% of patients had at least one medical comorbidity whereas 5.8% had multiple comorbidities. Overall, 77% of depressed patients were prescribed antidepressant medication. After controlling for age and sex, patients with multiple comorbidities were less likely to be prescribed medication (adjusted odds ratio, 0.58; 95% CI, 0.35-0.96), but there was no significant difference by individual comorbidities. Patients with cerebrovascular disease were less likely to be prescribed a full dose of medication (adjusted odds ratio, 0.26; 95% CI, 0.08-0.88), but there were no differences for other comorbidities or for multiple comorbidities, and there was no difference for any comorbidities in the prescription of minimally effective doses. Patients with new episodes of depression who present to a primary care practice are not treated more aggressively if they have medical comorbidities. In fact, patients with multiple comorbidities are treated somewhat less aggressively.

Implementation of a cloud-based electronic medical record for maternal and child health in rural Kenya.

PubMed

Haskew, John; Rø, Gunnar; Saito, Kaori; Turner, Kenrick; Odhiambo, George; Wamae, Annah; Sharif, Shahnaaz; Sugishita, Tomohiko

2015-05-01

Complete and timely health information is essential to inform public health decision-making for maternal and child health, but is often lacking in resource-constrained settings. Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care, and are particularly amenable to maternal and child health services. An EMR system could enable the mother and child to be tracked and monitored throughout maternity shared care, improve quality and completeness of data collected and enhance sharing of health information between outpatient clinic and the hospital, and between clinical and public health services to inform decision-making. This study implemented a novel cloud-based electronic medical record system in a maternal and child health outpatient setting in Western Kenya between April and June 2013 and evaluated its impact on improving completeness of data collected by clinical and public health services. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification. Significant improvements in completeness of the antenatal record were recorded through implementation of EMR-based data verification. A difference of 42.9% in missing data (including screening for hypertension, tuberculosis, malaria, HIV status or ART status of HIV positive women) was recorded pre- and post-implementation. Despite significant impact of EMR-based data verification on data completeness, overall screening rates in antenatal care were low. This study has shown that EMR-based data verification can improve the completeness of data collected in the patient record for maternal and child health. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality are recorded through implementation of this EMR model. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Evolution of Enterprise Imaging and the Role of the Radiologist in the New World.

PubMed

Petersilge, Cheryl A

2017-10-01

The concept of enterprise imaging is part of the next frontier in the evolution of health care technology. Incorporating all medical images into a single location integrated with electronic medical records supports care coordination and the ideal of a comprehensive longitudinal medical record. Radiologists have tremendous value to offer in support of the new concept of enterprise imaging, which extends outside the radiology department to encompass all image producers in a health care enterprise.

32 CFR Appendix A to Part 1285 - Gaining Access to DLA Records

Code of Federal Regulations, 2010 CFR

2010-07-01

..., medical, chemical, petroleum, industrial, construction, electronics, and general items of supply. The six... aircraft, surface ships, submarines, combat vehicles, and missile systems. b. Defense Electronics Supply... Center, Attn: DCSC-WXA, 3990 E. Broad Street, Columbus, OH 43216-5000. Defense Electronics Supply Center...

[Electronic medical records in Bosnia-Herzegovina. The electronic card--the medical record of the future in Boznia-Herzegovina].

PubMed

Masić, I; Pandza, H; Ridanović, Z; Dover, M

1997-01-01

The biggest problem in organisation of the effective and rational health care of good quality in Bosnia quality and Herzegovina is a functional and updated Health Information System. In this system, important role play Health Statistic System in which documentation and evidence are very important segment. Developed countries proceeded from the manual and semiautomatic method of medical data processing and system management to the new methods of entering, storage, transfer, searching and protection of data using electronic equipment. Recently, the competition between manufacturers of the Smart Card and Laser Card is reality. Also scientific and professional debate exists about the standard card for storage of medical information in Health Care System. First option is supported by West European countries that developing Smart Card called Eurocard and second by USA and Far East countries. Because the Health Care System and other segments of Society of Bosnia and Herzegovina innovate intensively similar systems, the authors of this article intend to open discussion, and to show advantages and failures of each technological medium.

Facilitating secondary use of medical data by using openEHR archetypes.

PubMed

Kohl, Christian D; Garde, Sebastian; Knaup, Petra

2010-01-01

Clinical trials are of high importance for medical progress. But even though more and more clinical data is available in electronic patient records (EPRs) and more and more electronic data capture (EDC) systems are used in trials, there is still a gap which makes EPR / EDC interoperability difficult and hampers secondary use of medical routine data. The openEHR architecture for Electronic Health Records is based on a two level modeling approach which makes use of 'archetypes'. We want to analyze whether archetypes can help to bridge this gap by building an integrated EPR / EDC system based on openEHR archetypes. We used the 'openEHR Reference Framework and Application' (Opereffa) and existing archetypes for medical data. Furthermore, we developed dedicated archetypes to document study meta data. We developed a first prototype implementation of an archetype based integrated EPR / EDC system. Next steps will be the evaluation of an extended prototype in a real clinical trial scenario. Opereffa was a good starting point for our work. OpenEHR archetypes proved useful for secondary use of health data.

Dynamic consent: a possible solution to improve patient confidence and trust in how electronic patient records are used in medical research.

PubMed

Williams, Hawys; Spencer, Karen; Sanders, Caroline; Lund, David; Whitley, Edgar A; Kaye, Jane; Dixon, William G

2015-01-13

With one million people treated every 36 hours, routinely collected UK National Health Service (NHS) health data has huge potential for medical research. Advances in data acquisition from electronic patient records (EPRs) means such data are increasingly digital and can be anonymised for research purposes. NHS England's care.data initiative recently sought to increase the amount and availability of such data. However, controversy and uncertainty following the care.data public awareness campaign led to a delay in rollout, indicating that the success of EPR data for medical research may be threatened by a loss of patient and public trust. The sharing of sensitive health care data can only be done through maintaining such trust in a constantly evolving ethicolegal and political landscape. We propose that a dynamic consent model, whereby patients can electronically control consent through time and receive information about the uses of their data, provides a transparent, flexible, and user-friendly means to maintain public trust. This could leverage the huge potential of the EPR for medical research and, ultimately, patient and societal benefit.

Automated extraction of clinical traits of multiple sclerosis in electronic medical records

PubMed Central

Davis, Mary F; Sriram, Subramaniam; Bush, William S; Denny, Joshua C; Haines, Jonathan L

2013-01-01

Objectives The clinical course of multiple sclerosis (MS) is highly variable, and research data collection is costly and time consuming. We evaluated natural language processing techniques applied to electronic medical records (EMR) to identify MS patients and the key clinical traits of their disease course. Materials and methods We used four algorithms based on ICD-9 codes, text keywords, and medications to identify individuals with MS from a de-identified, research version of the EMR at Vanderbilt University. Using a training dataset of the records of 899 individuals, algorithms were constructed to identify and extract detailed information regarding the clinical course of MS from the text of the medical records, including clinical subtype, presence of oligoclonal bands, year of diagnosis, year and origin of first symptom, Expanded Disability Status Scale (EDSS) scores, timed 25-foot walk scores, and MS medications. Algorithms were evaluated on a test set validated by two independent reviewers. Results We identified 5789 individuals with MS. For all clinical traits extracted, precision was at least 87% and specificity was greater than 80%. Recall values for clinical subtype, EDSS scores, and timed 25-foot walk scores were greater than 80%. Discussion and conclusion This collection of clinical data represents one of the largest databases of detailed, clinical traits available for research on MS. This work demonstrates that detailed clinical information is recorded in the EMR and can be extracted for research purposes with high reliability. PMID:24148554

The Scope and Direction of Health Informatics

NASA Technical Reports Server (NTRS)

McGinnis, Patrick J.

2001-01-01

Health Informatics (HI) is a dynamic discipline based upon the medical sciences, information sciences, and cognitive sciences. Its domain is can broadly be defined as medical information management. The purpose of this paper is to provide an overview of this domain, discuss the current "state of the art" , and indicate the likely growth areas for health informatics. The sources of information utilized in this paper are selected publications from the literature of Health Informatics, HI 5300: Introduction to Health Informatics, which is a course from the Department of Health Informatics at the University of Texas Houston Health Sciences Center, and the author's personal experience in practicing telemedicine and implementing an electronic medical record at the NASA Johnson Space Center. The conclusion is that the direction of Health Informatics is in the direction of data management, transfer, and representation via electronic medical records and the Internet.

Informed Consent: Does Anyone Really Understand What Is Contained In The Medical Record?

PubMed

Fenton, S H; Manion, F; Hsieh, K; Harris, M

2015-01-01

Despite efforts to provide standard definitions of terms such as "medical record", "computer-based patient record", "electronic medical record" and "electronic health record", the terms are still used interchangeably. Initiatives like data and information governance, research biorepositories, and learning health systems require availability and reuse of data, as well as common understandings of the scope for specific purposes. Lacking widely shared definitions, utilization of the afore-mentioned terms in research informed consent documents calls to question whether all participants in the research process - patients, information technology and regulatory staff, and the investigative team - fully understand what data and information they are asking to obtain and agreeing to share. This descriptive study explored the terminology used in research informed consent documents when describing patient data and information, asking the question "Does the use of the term "medical record" in the context of a research informed consent document accurately represent the scope of the data involved?" Informed consent document templates found on 17 Institutional Review Board (IRB) websites with Clinical and Translational Science Awards (CTSA) were searched for terms that appeared to be describing the data resources to be accessed. The National Library of Medicine's (NLM) Terminology Services was searched for definitions provided by key standards groups that deposit terminologies with the NLM. The results suggest research consent documents are using outdated terms to describe patient information, health care terminology systems need to consider the context of research for use cases, and that there is significant work to be done to assure the HIPAA Omnibus Rule is applied to contemporary activities such as biorepositories and learning health systems. "Medical record", a term used extensively in research informed consent documents, is ambiguous and does not serve us well in the context of contemporary information management and governance.

[Development of POCT and medical digital assistant for primary medical healthcare].

PubMed

Shi, Jun; Yan, Zhuang-Zhi; Pan, Zhi-Hao

2008-01-01

In this paper, we discuss the meaning, advantages and methods of applying the point of care testing (POCT) and medical digital assistant (MDA) to primary healthcare services. We also introduce the development of the POCT and MDA based on the electronic health record(EHR) system.

Fingerprint verification on medical image reporting system.

PubMed

Chen, Yen-Cheng; Chen, Liang-Kuang; Tsai, Ming-Dar; Chiu, Hou-Chang; Chiu, Jainn-Shiun; Chong, Chee-Fah

2008-03-01

The healthcare industry is recently going through extensive changes, through adoption of robust, interoperable healthcare information technology by means of electronic medical records (EMR). However, a major concern of EMR is adequate confidentiality of the individual records being managed electronically. Multiple access points over an open network like the Internet increases possible patient data interception. The obligation is on healthcare providers to procure information security solutions that do not hamper patient care while still providing the confidentiality of patient information. Medical images are also part of the EMR which need to be protected from unauthorized users. This study integrates the techniques of fingerprint verification, DICOM object, digital signature and digital envelope in order to ensure that access to the hospital Picture Archiving and Communication System (PACS) or radiology information system (RIS) is only by certified parties.

Interdisciplinary collaboration and the electronic medical record.

PubMed

Green, Shayla D; Thomas, Joan D

2008-01-01

To examine interdisciplinary collaboration via electronic medical records (EMRs) with a focus on physicians' perception of nursing documentation. Quality improvement project using a survey instrument. Tertiary care pediatric hospital. Thirty-seven physicians. Physicians perceptions of nursing documentation after EMR implementation Physicians desire nursing documentation with greater clarity and additional information. Physicians indicate checklists alone for patient assessment and intervention data are insufficient for effective nurse/physician collaboration. Narrative nursing summaries are invaluable references that guide medical treatment decisions. Physicians see detailed assessments and well-described interventions of nurses' as critical to their ability to effectively practice medicine. Health care technology is called to develop EMRs that enable nurses to document detailed patient data in a swift and straightforward manner. Joint collaboration between nurses, physicians, and technology specialists is recommended to develop effective EMR systems.

Informatics in radiology (infoRAD): multimedia extension of medical imaging resource center teaching files.

PubMed

Yang, Guo Liang; Aziz, Aamer; Narayanaswami, Banukumar; Anand, Ananthasubramaniam; Lim, C C Tchoyoson; Nowinski, Wieslaw Lucjan

2005-01-01

A new method has been developed for multimedia enhancement of electronic teaching files created by using the standard protocols and formats offered by the Medical Imaging Resource Center (MIRC) project of the Radiological Society of North America. The typical MIRC electronic teaching file consists of static pages only; with the new method, audio and visual content may be added to the MIRC electronic teaching file so that the entire image interpretation process can be recorded for teaching purposes. With an efficient system for encoding the audiovisual record of on-screen manipulation of radiologic images, the multimedia teaching files generated are small enough to be transmitted via the Internet with acceptable resolution. Students may respond with the addition of new audio and visual content and thereby participate in a discussion about a particular case. MIRC electronic teaching files with multimedia enhancement have the potential to augment the effectiveness of diagnostic radiology teaching. RSNA, 2005.

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

PubMed

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

2014-10-01

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

Clinical challenges associated with incorporation of nonradiology images into the electronic medical record

NASA Astrophysics Data System (ADS)

Siegel, Eliot L.; Reiner, Bruce I.

2001-08-01

To date, the majority of Picture Archival and Communication Systems (PACS) have been utilized only for capture, storage, and display of radiology and in some cases, nuclear medicine images. Medical images for other subspecialty areas are currently stored in local, independent systems, which typically are not accessible throughout the healthcare enterprise and do not communicate with other hospital information or image management systems. It is likely that during the next few years, healthcare centers will expand PAC system capability to incorporate these multimedia data or alternatively, hospital-wide electronic patient record systems will be able to provide this function.

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

PubMed

Bar-Lev, Shirly

2015-03-01

The design and implementation of an electronic medical record system pose significant epistemological and practical complexities. Despite optimistic assessments of their potential contribution to the quality of care, their implementation has been problematic, and their actual employment in various clinical settings remains controversial. Little is known about how their use actually mediates knowing. Employing a variety of qualitative research methods, this article attempts an answer by illustrating how omitting, editing and excessive reporting were employed as part of nurses' and physicians' political efforts to shape knowledge production and knowledge sharing in a technologically mediated healthcare setting. © 2015 Foundation for the Sociology of Health & Illness.

Health Information Systems.

PubMed

Sirintrapun, S Joseph; Artz, David R

2015-06-01

This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.

Doctors and the Web. Help your patients surf the Net safely.

PubMed

Grandinetti, D A

2000-03-06

The Internet promises to touch every aspect of a physician's professional life, from patient relations to access to clinical studies, from billing to patient records, from marketing to e-mail. To help you make sense of what may be the most profound force in medical practice today, we're kicking off a new series with this article on helping patients navigate the Internet. Future installments, which will run in our first issue of every month, will look at such topics as online patient charts; Web-based electronic medical records; services that electronically connect doctors with health plans, hospitals, and other providers; and online supply purchasing.

Electronic Medical Records (EMRs), Epidemiology, and Epistemology: Reflections on EMRs and Future Pediatric Clinical Research

PubMed Central

Wasserman, Richard C.

2011-01-01

Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research. PMID:21622040

Safeguarding Confidentiality in Electronic Health Records.

PubMed

Shenoy, Akhil; Appel, Jacob M

2017-04-01

Electronic health records (EHRs) offer significant advantages over paper charts, such as ease of portability, facilitated communication, and a decreased risk of medical errors; however, important ethical concerns related to patient confidentiality remain. Although legal protections have been implemented, in practice, EHRs may be still prone to breaches that threaten patient privacy. Potential safeguards are essential, and have been implemented especially in sensitive areas such as mental illness, substance abuse, and sexual health. Features of one institutional model are described that may illustrate the efforts to both ensure adequate transparency and ensure patient confidentiality. Trust and the therapeutic alliance are critical to the provider-patient relationship and quality healthcare services. All of the benefits of an EHR are only possible if patients retain confidence in the security and accuracy of their medical records.

Mission Medical Information System

NASA Technical Reports Server (NTRS)

Johnson-Throop, Kathy A.; Joe, John C.; Follansbee, Nicole M.

2008-01-01

This viewgraph presentation gives an overview of the Mission Medical Information System (MMIS). The topics include: 1) What is MMIS?; 2) MMIS Goals; 3) Terrestrial Health Information Technology Vision; 4) NASA Health Information Technology Needs; 5) Mission Medical Information System Components; 6) Electronic Medical Record; 7) Longitudinal Study of Astronaut Health (LSAH); 8) Methods; and 9) Data Submission Agreement (example).

Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy.

PubMed

Schenk, Elizabeth; Schleyer, Ruth; Jones, Cami R; Fincham, Sarah; Daratha, Kenn B; Monsen, Karen A

2018-04-23

Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost.

Discrepancies between the electronic medical record, the prescriptions in the Swedish national prescription repository and the current medication reported by patients.

PubMed

Ekedahl, Anders; Brosius, Helen; Jönsson, Julia; Karlsson, Hanna; Yngvesson, Maria

2011-11-01

To study discrepancies between (i) the prescribed current treatment stated by patients with congestive heart failure (CHF) compared with patients with other chronic diseases, (ii) the data in the medication list (ML) in the electronic medical record and (iii) the data in the prescription list (PL) on the prescriptions stored in the national prescription repository in Sweden, to determine current, noncurrent, duplicate and missing prescriptions. At one healthcare centre, a random sample of patients 18 years and older with a diagnosis of CHF, diabetes mellitus (DM) or osteoarthritis (OA) provided written informed consent to participate. Participants were interviewed by telephone on the prescribed current treatment. Of 161 invited patients (61 CHF, 50 DM and 50 OA), 66 patients were included. More than 80% of the patients had at least one discrepancy, a noncurrent, a duplicate or a missing prescription, in the ML and PL. The overall congruence for unique prescriptions on current treatment between the ML and the PL was only 55%. Patients with CHF had overall more discrepancies and patients with DM fewer discrepancies in the ML. Prescriptions for noncurrent treatment, duplicates and missing prescriptions are common in both the ML in the electronic medical record and the list on prescriptions stored in the Swedish National Prescription Repository. Patients with CHF had more discrepancies in the ML. The risk for medication errors in primary care due to incorrect information on prescribed treatment may be substantial. Copyright © 2011 John Wiley & Sons, Ltd.

A Pharmacy Blueprint for Electronic Medical Record Implementation Success

PubMed Central

Bach, David S.; Risko, Kenneth R.; Farber, Margo S.; Polk, Gregory J.

2015-01-01

Objective: Implementation of an integrated, electronic medical record (EMR) has been promoted as a means of improving patient safety and quality. While there are a few reports of such processes that incorporate computerized prescriber order entry, pharmacy verification, an electronic medication administration record (eMAR), point-of-care barcode scanning, and clinical decision support, there are no published reports on how a pharmacy department can best participate in implementing such a process across a multihospital health care system. Method: This article relates the experience of the design, build, deployment, and maintenance of an integrated EMR solution from the pharmacy perspective. It describes a 9-month planning and build phase and the subsequent rollout at 8 hospitals over the following 13 months. Results: Key components to success are identified, as well as a set of guiding principles that proved invaluable in decision making and dispute resolution. Labor/personnel requirements for the various stages of the process are discussed, as are issues involving medication workflow analysis, drug database considerations, the development of clinical order sets, and incorporation of bar-code scanning of medications. Recommended implementation and maintenance strategies are presented, and the impact of EMR implementation on the pharmacy practice model and revenue analysis are examined. Conclusion: Adherence to the principles and practices outlined in this article can assist pharmacy administrators and clinicians during all medication-related phases of the development, implementation, and maintenance of an EMR solution. Furthermore, review and incorporation of some or all of practices presented may help ease the process and ensure its success. PMID:26405340

Implementation of the Zambia Electronic Perinatal Record System for comprehensive prenatal and delivery care

PubMed Central

Chi, Benjamin H.; Vwalika, Bellington; Killam, William P.; Wamalume, Chibesa; Giganti, Mark J.; Mbewe, Reuben; Stringer, Elizabeth M.; Chintu, Namwinga T.; Putta, Nande B.; Liu, Katherine C.; Chibwesha, Carla J.; Rouse, Dwight J.; Stringer, Jeffrey S.A.

2011-01-01

Objective To characterize prenatal and delivery care in an urban African setting. Methods The Zambia Electronic Perinatal Record System (ZEPRS) was implemented to record demographic characteristics, past medical and obstetric history, prenatal care, and delivery and newborn care for pregnant women across 25 facilities in the Lusaka public health sector. Results From June 1, 2007, to January 31, 2010, 115 552 pregnant women had prenatal and delivery information recorded in ZEPRS. Median gestation age at first prenatal visit was 23 weeks (interquartile range [IQR] 19–26). Syphilis screening was documented in 95 663 (83%) pregnancies: 2449 (2.6%) women tested positive, of whom 1589 (64.9%) were treated appropriately. 111 108 (96%) women agreed to HIV testing, of whom 22% were diagnosed with HIV. Overall, 112 813 (98%) of recorded pregnancies resulted in a live birth, and 2739 (2%) in a stillbirth. The median gestational age was 38 weeks (IQR 35–40) at delivery; the median birth weight of newborns was 3000 g (IQR 2700–3300 g). Conclusion The results demonstrate the feasibility of using a comprehensive electronic medical record in an urban African setting, and highlight its important role in ongoing efforts to improve clinical care. PMID:21315347

Evaluation of a BCMA’s Electronic Medication Administration Record

PubMed Central

Staggers, Nancy; Iribarren, Sarah; Guo, Jia-Wen; Weir, Charlene

2015-01-01

Barcode medication administration (BCMA) systems can reduce medication errors, but sociotechnical issues are quite common. Although crucial to nurses’ work, few usability evaluations are available for electronic medication administration record screens (eMARs). The purpose of this research was to identify current usability problems in the VA’s eMAR/BCMA system and explore how these might impact nurses’ situation awareness. Three expert evaluators used 10 tasks/elements, heuristic evaluation techniques and explored potential impacts using a situation awareness perspective. The results yielded 99 usability problems categorized into 440 heuristic violations with the largest volume in the category of Match with the Real World. Fifteen usability issues were rated as catastrophic with the Administer/Chart medications task having the most. Situational awareness was impacted at all levels, especially at Level 2, Comprehension. Usability problems point to important areas for improvement because these issues have the potential to impact nurses’ situation awareness, “at a glance” information, nurse productivity and patient safety. PMID:25601936

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

PubMed

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

2011-01-01

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

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

PubMed Central

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

2011-01-01

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

Requirements for prototyping an educational electronic health record: experiences and future directions.

PubMed

Kushniruk, Andre; Borycki, Elizabeth; Kuo, Mu-Hsing; Parapini, Eric; Wang, Shu Lin; Ho, Kendall

2014-01-01

Electronic health records and related technologies are being increasingly deployed throughout the world. It is expected that upon graduation health professionals will be able to use these technologies in effective and efficient ways. However, educating health professional students about such technologies has lagged behind. There is a need for software that will allow medical, nursing and health informatics students access to this important software to learn how it works and how to use it effectively. Furthermore, electronic health record educational software that is accessed should provide a range of functions including allowing instructors to build patient cases. Such software should also allow for simulation of a course of a patient's stay and the ability to allow instructors to monitor student use of electronic health records. In this paper we describe our work in developing the requirements for an educational electronic health record to support education about this important technology. We also describe a prototype system being developed based on the requirements gathered.

Video requirements for remote medical diagnosis

NASA Technical Reports Server (NTRS)

Davis, J. G.

1974-01-01

Minimal television system requirements for medical telediagnosis were studied. The experiment was conducted with the aid of a simulated telemedicine system. The first step involved making high quality videotape recordings of actual medical examinations conducted by a skilled nurse under the direction of a physician watching on closed circuit television. These recordings formed the baseline for the study. Next, these videotape recordings were electronically degraded to simulate television systems of less than broadcast quality. Finally, the baseline and degraded video recordings were shown (via a statistically randomized procedure) to a large number of physicians who attempted to reach a correct medical diagnosis and to visually recognize key physical signs for each patient. By careful scoring and analysis of the results of these viewings, the pictorial and diagnostic limitations as a function of technical video characteristics were to be defined.

Automated processing of electronic medical records is a reliable method of determining aspirin use in populations at risk for cardiovascular events.

PubMed

Pakhomov, Serguei Vs; Shah, Nilay D; Hanson, Penny; Balasubramaniam, Saranya C; Smith, Steven A

2010-01-01

Low-dose aspirin reduces cardiovascular risk; however, monitoring over-the-counter medication use relies on the time-consuming and costly manual review of medical records. Our objective is to validate natural language processing (NLP) of the electronic medical record (EMR) for extracting medication exposure and contraindication information. The text of EMRs for 499 patients with type 2 diabetes was searched using NLP for evidence of aspirin use and its contraindications. The results were compared to a standardised manual records review. Of the 499 patients, 351 (70%) were using aspirin and 148 (30%) were not, according to manual review. NLP correctly identified 346 of the 351 aspirin-positive and 134 of the 148 aspirin-negative patients, indicating a sensitivity of 99% (95% CI 97-100) and specificity of 91% (95% CI 88-97). Of the 148 aspirin-negative patients, 66 (45%) had contraindications and 82 (55%) did not, according to manual review. NLP search for contraindications correctly identified 61 of the 66 patients with contraindications and 58 of the 82 patients without, yielding a sensitivity of 92% (95% CI 84-97) and a specificity of 71% (95% CI 60-80). NLP of the EMR is accurate in ascertaining documented aspirin use and could potentially be used for epidemiological research as a source of cardiovascular risk factor information.

Medical care providers' perspectives on dental information needs in electronic health records.

PubMed

Acharya, Amit; Shimpi, Neel; Mahnke, Andrea; Mathias, Richard; Ye, Zhan

2017-05-01

The authors conducted this study to identify the most relevant patient dental information in a medical-dental integrated electronic health record (iEHR) necessary for medical care providers to inform holistic treatment. The authors collected input from a diverse sample of 65 participants from a large, regional health system representing 13 medical specialties and administrative units. The authors collected feedback from participants through 11 focus group sessions. Two independent reviewers analyzed focus group transcripts to identify major and minor themes. The authors identified 336 of 385 annotations that most medical care providers coded as relevant. Annotations strongly supporting relevancy to clinical practice aligned with 18 major thematic categories, with the top 6 categories being communication, appointments, system design, medications, treatment plan, and dental alerts. Study participants identified dental data of highest relevance to medical care providers and recommended implementation of user-friendly access to dental data in iEHRs as crucial to holistic care delivery. Identification of the patients' dental information most relevant to medical care providers will inform strategies for improving the integration of that information into the medical-dental iEHR. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

Secure scalable disaster electronic medical record and tracking system.

PubMed

Demers, Gerard; Kahn, Christopher; Johansson, Per; Buono, Colleen; Chipara, Octav; Griswold, William; Chan, Theodore

2013-10-01

Electronic medical records (EMRs) are considered superior in documentation of care for medical practice. Current disaster medical response involves paper tracking systems and radio communication for mass-casualty incidents (MCIs). These systems are prone to errors, may be compromised by local conditions, and are labor intensive. Communication infrastructure may be impacted, overwhelmed by call volume, or destroyed by the disaster, making self-contained and secure EMR response a critical capability. Report As the prehospital disaster EMR allows for more robust content including protected health information (PHI), security measures must be instituted to safeguard these data. The Wireless Internet Information System for medicAl Response in Disasters (WIISARD) Research Group developed a handheld, linked, wireless EMR system utilizing current technology platforms. Smart phones connected to radio frequency identification (RFID) readers may be utilized to efficiently track casualties resulting from the incident. Medical information may be transmitted on an encrypted network to fellow prehospital team members, medical dispatch, and receiving medical centers. This system has been field tested in a number of exercises with excellent results, and future iterations will incorporate robust security measures. A secure prehospital triage EMR improves documentation quality during disaster drills.

Linking medical records to an expert system

NASA Technical Reports Server (NTRS)

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

1991-01-01

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

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

PubMed

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

2010-04-01

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

Integrated information systems for electronic chemotherapy medication administration.

PubMed

Levy, Mia A; Giuse, Dario A; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K

2011-07-01

Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations.

[From record keeping to scientific research: obstacles and opportunities for research with electronic health records].

PubMed

Scholte, R A; Opmeer, B C; Ploem, M C

2017-01-01

As a result of increasing digitisation of medical record keeping, electronic health records (EHRs) are an attractive source for data reuse. However, such record-based research is still suffering from poor quality of data stored in EHRs. Lack of consent for reuse of data also plays an impeding role, especially in retrospective record-based research. That said, increasing cooperation between healthcare institutions and current attention for EHR organisation also offer opportunities for record-based research. Patient data can be recorded in more standardised ways and in increasingly harmonised EHRs. In addition, if healthcare institutions were to establish a generic consent procedure - preferably with national scope - the potential of EHRs for scientific research could be exploited in considerably better ways.

Dr. Lindberg's Legacy : Charting A New Course | NIH MedlinePlus the Magazine

MedlinePlus

... technology, artificial intelligence, computer-aided medical diagnosis, and electronic health records. As the first President of the ... about it—when Don began, NLM had no electronic journals in its collection, few people owned personal ...

Improving Herpes Zoster Vaccination Rates Through Use of a Clinical Pharmacist and a Personal Health Record

PubMed Central

Otsuka, Shelley H.; Tayal, Neeraj H.; Porter, Kyle; Embi, Peter J.; Beatty, Stuart J.

2014-01-01

BACKGROUND Preventative health services, including herpes zoster vaccination rates, remain low despite known benefits. A new care model to improve preventative health services is warranted. The objective of this study is to investigate whether the functions of an electronic medical record, in combination with a pharmacist as part of the care team, can improve the herpes zoster vaccination rate. METHODS This study was a 6-month, randomized controlled trial at a General Internal Medicine clinic at The Ohio State University. The 2589 patients aged 60 years and older without documented herpes zoster vaccination in the electronic medical record were stratified on the basis of activated personal health record status, an online tool used to share health information between patient and provider. Of the 674 personal health record users, 250 were randomized to receive information regarding the herpes zoster vaccination via an electronic message and 424 were randomized to standard of care. Likewise, of the 1915 nonpersonal health record users, 250 were randomized to receive the same information via the US Postal Service and 1665 were randomized to standard of care. After pharmacist chart review, eligible patients were mailed a herpes zoster vaccine prescription. Herpes zoster vaccination rates were compared by chi-square tests. RESULTS Intervention recipients had significantly higher vaccination rates than controls in both personal health record (relative risk, 2.7; P = .0007) and nonpersonal health record (relative risk, 2.9; P = .0001) patient populations. CONCLUSIONS Communication outside of face-to-face office visits, by both personal health record electronic message and information by mail, can improve preventative health intervention rates compared with standard care. PMID:23830534

Are electronic health records ready for genomic medicine?

PubMed

Scheuner, Maren T; de Vries, Han; Kim, Benjamin; Meili, Robin C; Olmstead, Sarah H; Teleki, Stephanie

2009-07-01

The goal of this project was to assess genetic/genomic content in electronic health records. Semistructured interviews were conducted with key informants. Questions addressed documentation, organization, display, decision support and security of family history and genetic test information, and challenges and opportunities relating to integrating genetic/genomics content in electronic health records. There were 56 participants: 10 electronic health record specialists, 18 primary care clinicians, 16 medical geneticists, and 12 genetic counselors. Few clinicians felt their electronic record met their current genetic/genomic medicine needs. Barriers to integration were mostly related to problems with family history data collection, documentation, and organization. Lack of demand for genetics content and privacy concerns were also mentioned as challenges. Data elements and functionality requirements that clinicians see include: pedigree drawing; clinical decision support for familial risk assessment and genetic testing indications; a patient portal for patient-entered data; and standards for data elements, terminology, structure, interoperability, and clinical decision support rules. Although most said that there is little impact of genetics/genomics on electronic records today, many stated genetics/genomics would be a driver of content in the next 5-10 years. Electronic health records have the potential to enable clinical integration of genetic/genomic medicine and improve delivery of personalized health care; however, structured and standardized data elements and functionality requirements are needed.

Medical Device Plug-and-Play Interoperability Standards and Technology Leadership

DTIC Science & Technology

2010-10-01

Philips Medical Systems Impact of ARRA/HITECH on Device Connectivity: Safe? Effective? Say what?! Todd Cooper President Breakthrough Solutions...that could notify the physician when, say , one of the devices comes discon- nected in the high-vibration environment of the plane. There is no way at...Electronic record-keeping promises to be an improvement over previous methods (eliminating problems such as illeg- ible handwriting and records

Development of electronic medical record charting for hospital-based transfusion and apheresis medicine services: Early adoption perspectives

PubMed Central

Levy, Rebecca; Pantanowitz, Liron; Cloutier, Darlene; Provencher, Jean; McGirr, Joan; Stebbins, Jennifer; Cronin, Suzanne; Wherry, Josh; Fenton, Joseph; Donelan, Eileen; Johari, Vandita; Andrzejewski, Chester

2010-01-01

Background: Electronic medical records (EMRs) provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS) involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution's initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting) strategy within the EMR. Methods: A focus group of our hospital's transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium) for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater realered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encount by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also enhance data mining, quality improvement, and biovigilance monitoring activities. PMID:20805955

Can an alert in primary care electronic medical records increase participation in a population-based screening programme for colorectal cancer? COLO-ALERT, a randomised clinical trial

PubMed Central

2014-01-01

Background Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population’s reasons for refusing to take part in the screening programme and to find out the health professionals’ opinion about the official programme implementation and on the new computerised tool. Methods/Design This is a parallel randomised trial with a cross-sectional second stage. Participants: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50–69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient’s electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach. Discussion We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals. Trial registration Clinical Trials.gov identifier NCT01877018 PMID:24685117

IT and security considerations for online clinical records.

PubMed

Williams, Patricia A H

2010-03-01

E-health and the national electronic medical record are on our doorstep. As an integral part of the healthcare system, dentistry needs to get on board with this national initiative. How prepared is the dental profession for this? How can a culture of online clinical records be promoted and what protocols and infrastructure exist for this to occur? The lack of government restriction means that dentistry should be taking full advantage of what is possible. The benefits and barriers to adoption of online records will be presented to provide a frame of reference for the next major shift in electronic communication.

A First Standardized Swiss Electronic Maternity Record.

PubMed

Murbach, Michel; Martin, Sabine; Denecke, Kerstin; Nüssli, Stephan

2017-01-01

During the nine months of pregnancy, women have to regularly visit several physicians for continuous monitoring of the health and development of the fetus and mother. Comprehensive examination results of different types are generated in this process; documentation and data transmission standards are still unavailable or not in use. Relevant information is collected in a paper-based maternity record carried by the pregnant women. To improve availability and transmission of data, we aim at developing a first prototype for an electronic maternity record for Switzerland. By analyzing the documentation workflow during pregnancy, we determined a maternity record data set. Further, we collected requirements towards a digital maternity record. As data exchange format, the Swiss specific exchange format SMEEX (swiss medical data exchange) was exploited. Feedback from 27 potential users was collected to identify further improvements. The relevant data is extracted from the primary care information system as SMEEX file, stored in a database and made available in a web and a mobile application, developed as prototypes of an electronic maternity record. The user confirmed the usefulness of the system and provided multiple suggestions for an extension. An electronical maternity record as developed in this work could be in future linked to the electronic patient record.

The record of electrical and communication engineering conversazione Tohoku University Volume 63, No. 3

NASA Astrophysics Data System (ADS)

1995-05-01

English abstracts contained are from papers authored by the research staff of the Research Institute of Electrical Communication and the departments of Electrical Engineering, Electrical Communications, Electronic Engineering, and Information Engineering, Tohoku University, which originally appeared in scientific journals in 1994. The abstracts are organized under the following disciplines: electromagnetic theory; physics; fundamental theory of information; communication theory and systems; signal and image processing; systems control; computers; artificial intelligence; recording; acoustics and speech; ultrasonic electronics; antenna, propagation, and transmission; optoelectronics and optical communications; quantum electronics; superconducting materials and applications; magnetic materials and magnetics; semiconductors; electronic materials and parts; electronic devices and integrated circuits; electronic circuits; medical electronics and bionics; measurements and applied electronics; electric power; and miscellaneous.

An HL7/CDA Framework for the Design and Deployment of Telemedicine Services

DTIC Science & Technology

2001-10-25

schemes and prescription databases. Furthermore, interoperability with the Electronic Health Re- cord ( EHR ) facilitates automatic retrieval of relevant...local EHR system or the integrated electronic health record (I- EHR ) [9], which indexes all medical contacts of a patient in the regional net- work...suspected medical problem. Interoperability with middleware services of the HII and other data sources such as the local EHR sys- tem affects

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

PubMed

Kluge, E H

1999-12-01

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

Physician capability to electronically exchange clinical information, 2011.

PubMed

Patel, Vaishali; Swain, Matthew J; King, Jennifer; Furukawa, Michael F

2013-10-01

To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement. Survey of a nationally representative sample of nonfederal office-based physicians who provide direct patient care. The survey was administered by mail with telephone follow-up and had a 61% weighted response rate. The overall sample consisted of 4326 respondents. We calculated estimates of electronic exchange capability at the national and state levels, and applied multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics. In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries. In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians' capability to exchange varies by vendor and by state.

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

PubMed

Seo, Hwa Jeong; Kim, Hye Hyeon; Kim, Ju Han

2011-09-01

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

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

PubMed Central

Seo, Hwa Jeong; Kim, Hye Hyeon

2011-01-01

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

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record.

PubMed

Biagioli, Frances E; Elliot, Diane L; Palmer, Ryan T; Graichen, Carla C; Rdesinski, Rebecca E; Ashok Kumar, Kaparaboyna; Galper, Ari B; Tysinger, James W

2017-01-01

Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. The authors collected performance data for students (n = 71) at the first institution during academic years 2011-2013 and for students (n = 211) at the second institution during academic year 2013-2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students' EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Cross-institutional data comparisons will help determine whether differences in curricula affect students' EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.

Changes in Veteran Tobacco Use Identified in Electronic Medical Records.

PubMed

Barnett, Paul G; Chow, Adam; Flores, Nicole E; Sherman, Scott E; Duffy, Sonia A

2017-07-01

Electronic medical records represent a new source of longitudinal data on tobacco use. Electronic medical records of the U.S. Department of Veterans Affairs were extracted to find patients' tobacco use status in 2009 and at another assessment 12-24 months later. Records from the year prior to the first assessment were used to determine patient demographics and comorbidities. These data were analyzed in 2015. An annual quit rate of 12.0% was observed in 754,504 current tobacco users. Adjusted tobacco use prevalence at follow-up was 3.2% greater with alcohol use disorders at baseline, 1.9% greater with drug use disorders, 3.3% greater with schizophrenia, and lower in patients with cancer, heart disease, and other medical conditions (all differences statistically significant with p<0.05). Annual relapse rates in 412,979 former tobacco users were 29.6% in those who had quit for <1 year, 9.7% in those who had quit for 1-7 years, and 1.9% of those who had quit for >7 years. Among those who had quit for <1 year, adjusted relapse rates were 4.3% greater with alcohol use disorders and 7.2% greater with drug use disorders (statistically significant with p<0.05). High annual cessation rates may reflect the older age and greater comorbidities of the cohort or the intensive cessation efforts of the U.S. Department of Veterans Affairs. The lower cessation and higher relapse rates in psychiatric and substance use disorders suggest that these groups will need intensive and sustained cessation efforts. Published by Elsevier Inc.

Comparison of information content of structured and narrative text data sources on the example of medication intensification.

PubMed

Turchin, Alexander; Shubina, Maria; Breydo, Eugene; Pendergrass, Merri L; Einbinder, Jonathan S

2009-01-01

OBJECTIVE To compare information obtained from narrative and structured electronic sources using anti-hypertensive medication intensification as an example clinical issue of interest. DESIGN A retrospective cohort study of 5,634 hypertensive patients with diabetes from 2000 to 2005. MEASUREMENTS The authors determined the fraction of medication intensification events documented in both narrative and structured data in the electronic medical record. The authors analyzed the relationship between provider characteristics and concordance between intensifications in narrative and structured data. As there is no gold standard data source for medication information, the authors clinically validated medication intensification information by assessing the relationship between documented medication intensification and the patients' blood pressure in univariate and multivariate models. RESULTS Overall, 5,627 (30.9%) of 18,185 medication intensification events were documented in both sources. For a medication intensification event documented in narrative notes the probability of a concordant entry in structured records increased by 11% for each study year (p < 0.0001) and decreased by 19% for each decade of provider age (p = 0.035). In a multivariate model that adjusted for patient demographics and intraphysician correlations, an increase of one medication intensification per month documented in either narrative or structured data were associated with a 5-8 mm Hg monthly decrease in systolic and 1.5-4 mm Hg decrease in diastolic blood pressure (p < 0.0001 for all). CONCLUSION Narrative and structured electronic data sources provide complementary information on anti-hypertensive medication intensification. Clinical validity of information in both sources was demonstrated by correlation with changes in blood pressure.

Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence.

PubMed

Bosworth, Hayden B; Zullig, Leah L; Mendys, Phil; Ho, Michael; Trygstad, Troy; Granger, Christopher; Oakes, Megan M; Granger, Bradi B

2016-03-15

The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. 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. 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. 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. 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.

Implementation of a Novel Electronic Health Record-Embedded Physician Orders for Life-Sustaining Treatment System.

PubMed

Zive, Dana M; Cook, Jennifer; Yang, Charissa; Sibell, David; Tolle, Susan W; Lieberman, Michael

2016-11-01

In April 2015, Oregon Health & Science University (OHSU) deployed a web-based, electronic medical record-embedded application created by third party vendor Vynca Inc. to allow real-time education, and completion of Physician Orders for Life Sustaining Treatment (POLST). Forms are automatically linked to the Epic Systems™ electronic health record (EHR) patient header and submitted to a state Registry, improving efficiency, accuracy, and rapid access to and retrieval of these important medical orders. POLST Forms, implemented in Oregon in 1992, are standardized portable medical orders used to document patient treatment goals for end-of-life care. In 2009, Oregon developed the first POLST-only statewide registry with a legislative mandate requiring POLST form signers to register the form unless the patient opts out. The Registry offers 24/7 emergency access to POLST Forms for Emergency Medical Services, Emergency Departments, and Acute Care Units. Because POLST is intended for those nearing end of life, immediate access to these forms at the time of an emergency is critical. Delays in registering a POLST Form may result in unwanted treatment if the paper form is not immediately available. An electronic POLST Form completion system (ePOLST) was implemented to support direct Registry submission. Other benefits of the system include single-sign-on, transmission of HL7 data for patient demographics and other relevant information, elimination of potential errors in form completion using internalized logic, built-in real-time video and text-based education materials for both patients and health care professionals, and mobile linkage for signature capture.

Using RxNorm and NDF-RT to classify medication data extracted from electronic health records: experiences from the Rochester Epidemiology Project.

PubMed

Pathak, Jyotishman; Murphy, Sean P; Willaert, Brian N; Kremers, Hilal M; Yawn, Barbara P; Rocca, Walter A; Chute, Christopher G

2011-01-01

RxNorm and NDF-RT published by the National Library of Medicine (NLM) and Veterans Affairs (VA), respectively, are two publicly available federal medication terminologies. In this study, we evaluate the applicability of RxNorm and National Drug File-Reference Terminology (NDF-RT) for extraction and classification of medication data retrieved using structured querying and natural language processing techniques from electronic health records at two different medical centers within the Rochester Epidemiology Project (REP). Specifically, we explore how mappings between RxNorm concept codes and NDF-RT drug classes can be leveraged for hierarchical organization and grouping of REP medication data, identify gaps and coverage issues, and analyze the recently released NLM's NDF-RT Web service API. Our study concludes that RxNorm and NDF-RT can be applied together for classification of medication extracted from multiple EHR systems, although several issues and challenges remain to be addressed. We further conclude that the Web service APIs developed by the NLM provide useful functionalities for such activities.

Long-term changes of information environments and computer anxiety of nurse administrators in Japan.

PubMed

Majima, Yukie; Izumi, Takako

2013-01-01

In Japan, medical information systems, including electronic medical records, are being introduced increasingly at medical and nursing fields. Nurse administrators, who are involved in the introduction of medical information systems and who must make proper judgment, are particularly required to have at least minimal knowledge of computers and networks and the ability to think about easy-to-use medical information systems. However, few of the current generation of nurse administrators studied information science subjects in their basic education curriculum. It can be said that information education for nurse administrators has become a pressing issue. Consequently, in this study, we conducted a survey of participants taking the first level program of the education course for Japanese certified nurse administrators to ascertain the actual conditions, such as the information environments that nurse administrators are in, their anxiety attitude to computers. Comparisons over the seven years since 2004 revealed that although introduction of electronic medical records in hospitals was progressing, little change in attributes of participants taking the course was observed, such as computer anxiety.

Lead User Design: Medication Management in Electronic Medical Records.

PubMed

Price, Morgan; Weber, Jens H; Davies, Iryna; Bellwood, Paule

2015-01-01

Improvements in medication management may lead to a reduction of preventable errors. Usability and user experience issues are common and related to achieving benefits of Electronic Medical Records (EMRs). This paper reports on a novel study that combines the lead user method with a safety engineering review to discover an innovative design for the medication management module in EMRs in primary care. Eight lead users were recruited that represented prescribers and clinical pharmacists with expertise in EMR design, evidence-based medicine, medication safety and medication research. Eight separate medication management module designs were prototyped and validated, one with each lead user. A parallel safety review of medicaiton management was completed. The findings were synthesized into a single common set of goals, activities and one interactive, visual prototype. The lead user method with safety review proved to be an effective way to elicit diverse user goals and synthesize them into a common design. The resulting design ideas focus on meeting the goals of quality, efficiency, safety, reducing the cognitive load on the user, and improving communication wih the patient and the care team. Design ideas are being adapted to an existing EMR product, providing areas for further work.

Integrating all medical records to an enterprise viewer.

PubMed

Li, Haomin; Duan, Huilong; Lu, Xudong; Zhao, Chenhui; An, Jiye

2005-01-01

The idea behind hospital information systems is to make all of a patient's medical reports, lab results, and images electronically available to clinicians, instantaneously, wherever they are. But the higgledy-piggledy evolution of most hospital computer systems makes it hard to integrate all these clinical records. Although several integration standards had been proposed to meet this challenger, none of them is fit to Chinese hospitals. In this paper, we introduce our work of implementing a three-tiered architecture enterprise viewer in Huzhou Central Hospital to integration all existing medical information systems using limited resource.

Electronic Health Record Implementation: A SWOT Analysis.

PubMed

Shahmoradi, Leila; Darrudi, Alireza; Arji, Goli; Farzaneh Nejad, Ahmadreza

2017-10-01

Electronic Health Record (EHR) is one of the most important achievements of information technology in healthcare domain, and if deployed effectively, it can yield predominant results. The aim of this study was a SWOT (strengths, weaknesses, opportunities, and threats) analysis in electronic health record implementation. This is a descriptive, analytical study conducted with the participation of a 90-member work force from Hospitals affiliated to Tehran University of Medical Sciences (TUMS). The data were collected by using a self-structured questionnaire and analyzed by SPSS software. Based on the results, the highest priority in strength analysis was related to timely and quick access to information. However, lack of hardware and infrastructures was the most important weakness. Having the potential to share information between different sectors and access to a variety of health statistics was the significant opportunity of EHR. Finally, the most substantial threats were the lack of strategic planning in the field of electronic health records together with physicians' and other clinical staff's resistance in the use of electronic health records. To facilitate successful adoption of electronic health record, some organizational, technical and resource elements contribute; moreover, the consideration of these factors is essential for HER implementation.

Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave.

PubMed

Quade, G; Novotny, J; Burde, B; May, F; Beck, L E; Goldschmidt, A

1999-01-01

A distributed multimedia electronic patient record (EPR) is a central component of a medicine-telematics application that supports physicians working in rural areas of South America, and offers medical services to scientists in Antarctica. A Hyperwave server is used to maintain the patient record. As opposed to common web servers--and as a second generation web server--Hyperwave provides the capability of holding documents in a distributed web space without the problem of broken links. This enables physicians to browse through a patient's record by using a standard browser even if the patient's record is distributed over several servers. The patient record is basically implemented on the "Good European Health Record" (GEHR) architecture.

Electronic health record use, intensity of hospital care, and patient outcomes.

PubMed

Blecker, Saul; Goldfeld, Keith; Park, Naeun; Shine, Daniel; Austrian, Jonathan S; Braithwaite, R Scott; Radford, Martha J; Gourevitch, Marc N

2014-03-01

Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity. Copyright © 2014 Elsevier Inc. All rights reserved.

FRR: fair remote retrieval of outsourced private medical records in electronic health networks.

PubMed

Wang, Huaqun; Wu, Qianhong; Qin, Bo; Domingo-Ferrer, Josep

2014-08-01

Cloud computing is emerging as the next-generation IT architecture. However, cloud computing also raises security and privacy concerns since the users have no physical control over the outsourced data. This paper focuses on fairly retrieving encrypted private medical records outsourced to remote untrusted cloud servers in the case of medical accidents and disputes. Our goal is to enable an independent committee to fairly recover the original private medical records so that medical investigation can be carried out in a convincing way. We achieve this goal with a fair remote retrieval (FRR) model in which either t investigation committee members cooperatively retrieve the original medical data or none of them can get any information on the medical records. We realize the first FRR scheme by exploiting fair multi-member key exchange and homomorphic privately verifiable tags. Based on the standard computational Diffie-Hellman (CDH) assumption, our scheme is provably secure in the random oracle model (ROM). A detailed performance analysis and experimental results show that our scheme is efficient in terms of communication and computation. Copyright © 2014 Elsevier Inc. All rights reserved.

Stepping Up to the Plate: An Agenda for Research and Policy Action on Electronic Medical Records in Canadian Primary Healthcare.

PubMed

Terry, Amanda L; Stewart, Moira; Fortin, Martin; Wong, Sabrina T; Grava-Gubins, Inese; Ashley, Lisa; Sullivan-Taylor, Patricia; Sullivan, Frank; Zucker, Lynne; Thind, Amardeep

2016-11-01

Building on a previous study, which identified gaps in primary healthcare electronic medical record (emr) research and knowledge, a one-day conference was held to facilitate a strategic discussion of these issues. This paper offers a multi-faceted research agenda and suggestions for policy actions as a way forward in bridging the gaps. one facet focuses on the need for research. The second facet focuses on harnessing the knowledge of primary healthcare emr stakeholders. finally, the third facet focuses on policy actions. this paper offers consensus-based suggestions with a view to improving the overall primary healthcare emr landscape in canada. Copyright © 2016 Longwoods Publishing.

Using the NASA Task Load Index to Assess Workload in Electronic Medical Records.

PubMed

Hudson, Darren; Kushniruk, Andre W; Borycki, Elizabeth M

2015-01-01

Electronic medical records (EMRs) has been expected to decrease health professional workload. The NASA Task Load Index has become an important tool for assessing workload in many domains. However, its application in assessing the impact of an EMR on nurse's workload has remained to be explored. In this paper we report the results of a study of workload and we explore the utility of applying the NASA Task Load Index to assess impact of an EMR at the end of its lifecycle on nurses' workload. It was found that mental and temporal demands were the most responsible for the workload. Further work along these lines is recommended.

Change management - recommendations for successful electronic medical records implementation.

PubMed

Shoolin, J S

2010-01-01

Change is difficult and managing change even more so. With the advent of Electronic Medical Records (EMRs) and the difficulty of its acceptance, understanding physician's attitudes and the psychology of change management is imperative. While many authors describe change management theories, one comes nearest to describing this particularly difficult transition. In 1969, Elizabeth Kübler-Ross wrote her seminal treatise, On Death and Dying, detailing the psychological changes terminally ill patients undergo. Her grieving model is a template to examine the impact of change. By following a physician through the EMR maze, understanding the difficulties he/she perceives and developing a plan other change agents are able to use, the paper gives practical recommendations to EMR change management.

The Heart of the Matter: Increasing Quality and Charge Capture from Intraoperative Transesophageal Echocardiography.

PubMed

Sanford, Joseph A; Kadry, Bassam; Oakes, Daryl; Macario, Alex; Schmiesing, Cliff

2016-04-15

Although transesophageal echocardiography is routinely performed at our institution, there is no easy way to document the procedure in the electronic medical record and generate a bill compliant with reimbursement requirements. We present the results of a quality improvement project that used agile development methodology to incorporate intraoperative transesophageal echocardiography into the electronic medical record. We discuss improvements in the quality of clinical documentation, technical workflow challenges overcome, and cost and time to return on investment. Billing was increased from an average of 36% to 84.6% when compared with the same time period in the previous year. The expected recoupment of investment for this project is just 18 weeks.

Healthcare provider education to support integration of pharmacogenomics in practice: the eMERGE Network experience

PubMed Central

Rohrer Vitek, Carolyn R; Abul-Husn, Noura S; Connolly, John J; Hartzler, Andrea L; Kitchner, Terrie; Peterson, Josh F; Rasmussen, Luke V; Smith, Maureen E; Stallings, Sarah; Williams, Marc S; Wolf, Wendy A; Prows, Cynthia A

2017-01-01

Ten organizations within the Electronic Medical Records and Genomics Network developed programs to implement pharmacogenomic sequencing and clinical decision support into clinical settings. Recognizing the importance of informed prescribers, a variety of strategies were used to incorporate provider education to support implementation. Education experiences with pharmacogenomics are described within the context of each organization's prior involvement, including the scope and scale of implementation specific to their Electronic Medical Records and Genomics projects. We describe common and distinct education strategies, provide exemplars and share challenges. Lessons learned inform future perspectives. Future pharmacogenomics clinical implementation initiatives need to include funding toward implementing provider education and evaluating outcomes. PMID:28639489

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

PubMed

Pantanowitz, Liron; Labranche, Wayne; Lareau, William

2010-05-26

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

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

PubMed Central

Pantanowitz, Liron; LaBranche, Wayne; Lareau, William

2010-01-01

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

A Conceptual Model for Increasing Use of Electronic Medical Records by Primary Care Physicians Through End-User Support.

PubMed

Randhawa, Gurprit K

2017-01-01

A conceptual model for exploring the relationship between end-user support (EUS) and electronic medical record (EMR) use by primary care physicians is presented. The model was developed following a review of conceptual and theoretical frameworks related to technology adoption/use and EUS. The model includes (a) one core construct (facilitating conditions), (b) four antecedents and one postcedent of facilitating conditions, and (c) four moderators. EMR use behaviour is the key outcome of the model. The proposed conceptual model should be tested. The model may be used to inform planning and decision-making for EMR implementations to increase EMR use for benefits realization.

Electronic Procedures for Medical Operations

NASA Technical Reports Server (NTRS)

2015-01-01

Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record.

PubMed

Artis, Kathryn A; Dyer, Edward; Mohan, Vishnu; Gold, Jeffrey A

2017-02-01

Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters' paper prerounding notes. Twenty-six-bed academic medical ICU with a well-established electronic health record. ICU rounds presenter (medical student or resident physician), interprofessional rounding team. None. During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3% of presentations but tools contained only 78% of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9% of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8% of all laboratory misrepresentations were detected. Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized.

Current patient and healthcare worker attitudes to eHealth and the personally controlled electronic health record in major hospitals.

PubMed

Armani, R; Mitchell, L E; Allen-Graham, J; Heriot, N R; Kotsimbos, T; Wilson, J W

2016-06-01

The current health system in Australia is comprised of both electronic- and paper-based medical records. The Federal Government has approved funding for the development of an individual health identifier and a universally adopted online health repository. To determine attitudes and beliefs of patients and healthcare workers regarding the use of stored medical information and the personally controlled electronic health record (PCEHR) in selected major hospitals in Victoria. Qualitative survey of patients and healthcare workers (n = 600 each group) conducted during 2014 across five major hospitals in Melbourne to measure the awareness, attitudes and barriers to electronic health and the PCEHR. Of the patients, 93.3% support the concept of a shared electronic healthcare record, 33.7% were aware of the PCEHR and only 11% had registered. The majority of healthcare workers believed that the presence of a shared health record would result in an increased appropriateness of care and patient safety by reducing adverse drug events and improving the timeliness of care provided. However, only 46% of healthcare workers were aware of the PCEHR. This study provides a baseline evaluation of perceptions surrounding eHealth and PCHER in acute health services in five metropolitan centres. While there appears to be a readiness for adoption of these strategies for healthcare documentation, patients require motivation to register for the PCEHR, and healthcare workers require more information on the potential benefits to them to achieve more timely and efficient care. © 2016 Royal Australasian College of Physicians.

Spatial-temporal clustering of companion animal enteric syndrome: detection and investigation through the use of electronic medical records from participating private practices.

PubMed

Anholt, R M; Berezowski, J; Robertson, C; Stephen, C

2015-09-01

There is interest in the potential of companion animal surveillance to provide data to improve pet health and to provide early warning of environmental hazards to people. We implemented a companion animal surveillance system in Calgary, Alberta and the surrounding communities. Informatics technologies automatically extracted electronic medical records from participating veterinary practices and identified cases of enteric syndrome in the warehoused records. The data were analysed using time-series analyses and a retrospective space-time permutation scan statistic. We identified a seasonal pattern of reports of occurrences of enteric syndromes in companion animals and four statistically significant clusters of enteric syndrome cases. The cases within each cluster were examined and information about the animals involved (species, age, sex), their vaccination history, possible exposure or risk behaviour history, information about disease severity, and the aetiological diagnosis was collected. We then assessed whether the cases within the cluster were unusual and if they represented an animal or public health threat. There was often insufficient information recorded in the medical record to characterize the clusters by aetiology or exposures. Space-time analysis of companion animal enteric syndrome cases found evidence of clustering. Collection of more epidemiologically relevant data would enhance the utility of practice-based companion animal surveillance.

Adherence to hydroxyurea medication by children with sickle cell disease (SCD) using an electronic device: a feasibility study.

PubMed

Inoue, Susumu; Kodjebacheva, Gergana; Scherrer, Tammy; Rice, Gary; Grigorian, Matthew; Blankenship, Jeremy; Onwuzurike, Nkechi

2016-08-01

Adherence to hydroxyurea (HU) is a significant modifying factor in sickle cell vaso-occlusive pain. We conducted a study using an electronic medication container-monitor-reminder device (GlowCap™) to track adherence and determine whether use of this device affected rates of HU adherence. Subjects were regular attendees to our clinic. They were given a 37-item questionnaire and were asked to use a GlowCap containing HU. When the device cap is opened, it makes a remote "medication taken" record. The device also provides usage reminder in the form of lights and alarm sounds if the cap opening is delayed. Nineteen subjects participated in the survey, and 17 in the intervention phase. Of the 17, 12 had reliable adherence data. Seventeen caregivers of patients and two patients completed the survey. Two most common barriers to adherence identified were lack of reminders and absence of medicine home delivery. The intervention component of this study, which used both the electronic (GlowCap) method and medication possession ratio showed that the median adherence rate for the 12 patients evaluated was 85 %. The GlowCap device accurately kept a record of adherence rates. This device may be an effective tool for increasing HU medication adherence.

Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record

PubMed Central

Wright, Adam; Sittig, Dean F; McGowan, Julie; Ash, Joan S; Weed, Lawrence L

2014-01-01

Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software—over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done. PMID:24872343

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

PubMed

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

2013-01-01

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

Discovering medical conditions associated with periodontitis using linked electronic health records

PubMed Central

Boland, Mary Regina; Hripcsak, George; Albers, David J.; Wei, Ying; Wilcox, Adam B.; Wei, Jin; Li, Jianhua; Lin, Steven; Breene, Michael; Myers, Ronnie; Zimmerman, John; Papapanou, Panos N.; Weng, Chunhua

2013-01-01

Aim To use linked electronic medical and dental records to discover associations between periodontitis and medical conditions independent of a priori hypotheses. Materials and Methods This case-control study included 2475 patients who underwent dental treatment at the College of Dental Medicine at Columbia University and medical treatment at NewYork-Presbyterian Hospital. Our cases are patients who received periodontal treatment and our controls are patients who received dental maintenance but no periodontal treatment. Chi-square analysis was performed for medical treatment codes and logistic regression was used to adjust for confounders. Results Our method replicated several important periodontitis associations in a largely Hispanic population, including diabetes mellitus type I (OR = 1.6, 95% CI 1.30–1.99, p < 0.001) and type II (OR = 1.4, 95% CI 1.22–1.67, p < 0.001), hypertension (OR = 1.2, 95% CI 1.10–1.37, p < 0.001), hypercholesterolaemia (OR = 1.2, 95% CI 1.07–1.38, p = 0.004), hyperlipidaemia (OR = 1.2, 95% CI 1.06–1.43, p = 0.008) and conditions pertaining to pregnancy and childbirth (OR = 2.9, 95% CI: 1.32–7.21, p = 0.014). We also found a previously unreported association with benign prostatic hyperplasia (OR = 1.5, 95% CI 1.05–2.10, p = 0.026) after adjusting for age, gender, ethnicity, hypertension, diabetes, obesity, lipid and circulatory system conditions, alcohol and tobacco abuse. Conclusions This study contributes a high-throughput method for associating periodontitis with systemic diseases using linked electronic records. PMID:23495669

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

PubMed

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

2017-11-30

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

[Electronic data records in primary health care and aspects of their development in Bosnia and Herzegovina].

PubMed

Novo, Ahmed; Masić, Izet; Toromanović, Selim; Karić, Mediha; Zunić, Lejla

2004-01-01

In Medical Informatics medical documentation and evidention are most probably the key areas. Also, in primary health care it is very important and part of daily activity of medical staff. Bosnia and Herzegovina is trying to be close to developed countries and to modernize and computerize current systems of documentation and to cross over from manual and semi manual methods to computerized medical data analysis. The most of European countries have developed standards and classification systems in primary health care for collecting, examination, analysis and interpretation of medical data assessed. One of possibilities as well as dilemma, which data carrier should be used for storage and manipulation of patient data in primary health care, is use of electronic medical record. Most of the South East European countries use chip or smart card and some of countries in neighborhood (Italy) choose laser card as patient data carrier. Both technologies have the advantages and disadvantages what was comprehensively colaborated by the authors in this paper, with intention to help experts who make decisions in this segment to create and to correctly influence on improvement of quality, correctness and accuracy of medical documentation in primary health care.

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

PubMed

Eggli, S; Holm, J

2001-12-01

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

The Research and Application of Information Platform About Community Support Intervention for Patients with Alcohol Dependence.

PubMed

Yang, Liqun

2016-01-01

Through the establishment of electronic health records, health education and measures such as regional information sharing platform, we explored the management of patients with alcohol dependence living in communities and established a medical information resource sharing model between mental hospital-community to strengthen the supportive intervention management of patients with alcohol dependence, improve the effect of intervention and reduce the rate of compound drink. To design the questionnaire of health state for patients with alcohol dependence. After data collection. We should establish electronic health records and community support intervention, make medical health card with terminal configuration card reader in both mental hospitals and community, develop information platform, establish a variety of supporting interventions and the service function modules, unblock information sharing between hospitals and community to make full use of the platform to carry out health education and health intervention management. The effectives of community supportive intervention are improved, rehabilitation rate of patients is reduced greatly, bad ways of life behavior are better. Establishing electronic health records is an important mean of community supportive interventions which is good for Real-time, dynamic management and promoting self-management skills making the dream of medical information resource between hospital-community sharing come true.

Managing the life cycle of electronic clinical documents.

PubMed

Payne, Thomas H; Graham, Gail

2006-01-01

To develop a model of the life cycle of clinical documents from inception to use in a person's medical record, including workflow requirements from clinical practice, local policy, and regulation. We propose a model for the life cycle of clinical documents as a framework for research on documentation within electronic medical record (EMR) systems. Our proposed model includes three axes: the stages of the document, the roles of those involved with the document, and the actions those involved may take on the document at each stage. The model includes the rules to describe who (in what role) can perform what actions on the document, and at what stages they can perform them. Rules are derived from needs of clinicians, and requirements of hospital bylaws and regulators. Our model encompasses current practices for paper medical records and workflow in some EMR systems. Commercial EMR systems include methods for implementing document workflow rules. Workflow rules that are part of this model mirror functionality in the Department of Veterans Affairs (VA) EMR system where the Authorization/ Subscription Utility permits document life cycle rules to be written in English-like fashion. Creating a model of the life cycle of clinical documents serves as a framework for discussion of document workflow, how rules governing workflow can be implemented in EMR systems, and future research of electronic documentation.

An Internet-Based Method for Extracting Nursing Home Resident Sedative Medication Data From Pharmacy Packing Systems: Descriptive Evaluation

PubMed Central

Gee, Peter; Westbury, Juanita; Bindoff, Ivan; Peterson, Gregory

2017-01-01

Background Inappropriate use of sedating medication has been reported in nursing homes for several decades. The Reducing Use of Sedatives (RedUSe) project was designed to address this issue through a combination of audit, feedback, staff education, and medication review. The project significantly reduced sedative use in a controlled trial of 25 Tasmanian nursing homes. To expand the project to 150 nursing homes across Australia, an improved and scalable method of data collection was required. This paper describes and evaluates a method for remotely extracting, transforming, and validating electronic resident and medication data from community pharmacies supplying medications to nursing homes. Objective The aim of this study was to develop and evaluate an electronic method for extracting and enriching data on psychotropic medication use in nursing homes, on a national scale. Methods An application uploaded resident details and medication data from computerized medication packing systems in the pharmacies supplying participating nursing homes. The server converted medication codes used by the packing systems to Australian Medicines Terminology coding and subsequently to Anatomical Therapeutic Chemical (ATC) codes for grouping. Medications of interest, in this case antipsychotics and benzodiazepines, were automatically identified and quantified during the upload. This data was then validated on the Web by project staff and a “champion nurse” at the participating home. Results Of participating nursing homes, 94.6% (142/150) had resident and medication records uploaded. Facilitating an upload for one pharmacy took an average of 15 min. A total of 17,722 resident profiles were extracted, representing 95.6% (17,722/18,537) of the homes’ residents. For these, 546,535 medication records were extracted, of which, 28,053 were identified as antipsychotics or benzodiazepines. Of these, 8.17% (2291/28,053) were modified during validation and verification stages, and 4.75% (1398/29,451) were added. The champion nurse required a mean of 33 min website interaction to verify data, compared with 60 min for manual data entry. Conclusions The results show that the electronic data collection process is accurate: 95.25% (28,053/29,451) of sedative medications being taken by residents were identified and, of those, 91.83% (25,762/28,053) were correct without any manual intervention. The process worked effectively for nearly all homes. Although the pharmacy packing systems contain some invalid patient records, and data is sometimes incorrectly recorded, validation steps can overcome these problems and provide sufficiently accurate data for the purposes of reporting medication use in individual nursing homes. PMID:28778844

Electronic multidimensional health assessment questionnaire (eMDHAQ): past, present and future of a proposed single data management system for clinical care, research, quality improvement, and monitoring of long-term outcomes.

PubMed

Pincus, Theodore

2016-01-01

An MDHAQ/RAPID3 (multidimensional health assessment questionnaire/routine assessment of patient index data) was developed from the HAQ over 25 years, based on observations made from completion by every patient (with all diagnoses) at every routine rheumatology visit since 1980. Modification of the HAQ was viewed as similar to improving a laboratory test, with a primary focus on clinical value for diagnosis, prognosis, and/or management, as well as feasibility for minimal effect on clinical workflow. Rigorous attention, was also directed to validity, reliability, other methodologic and technological considerations, but after clinical value and feasibility were established. A longer "intake" MDHAQ was introduced for new patients to record a complete past medical history - illnesses, hospitalisations, surgeries, allergies, family history, social history and medications. MDHAQ scales not found on the HAQ record complex activities, sleep quality, anxiety, depression, self-report joint count, fatigue, symptom checklist, morning stiffness, exercise status, recent medical history, social history and demographic data within 2 pages on one sheet of paper. An electronic eMDHAQ/RAPID3 provides a similar platform to pool data from multiple sites. A patient may be offered a patient-administered, password-protected, secure, web site, to store the medical history completed on the eMDHAQ. This eMDHAQ would allow a patient to complete a single general medical history questionnaire rather than different intake questionnaires in different medical settings. The eMDHAQ would be available for updates and correction by the patient for future visits, regardless of electronic medical record (EMR). The eMDHAQ is designed to interface with an EMR using HL7 (health level seven) and SMART (Substitutable Medical Apps, Reusable Technology) on FHIR (Fast Healthcare Interoperability Resources), although implementation requires collaboration with the EMR vendor. Advanced features include reports for the physician formatted as a medical record note of past medical history for entry into any EMR without typing or dictation, and a periodic "tickler" function to monitor long-term outcomes with minimal effort of the physician and staff. Nonetheless, clinical use of an eMDHAQ should be guided primarily not by the latest technology, but by value and feasibility in clinical care, the same principles that guided development of the pencil-and-paper MDHAQ/RAPID3.

Integrated Information Systems for Electronic Chemotherapy Medication Administration

PubMed Central

Levy, Mia A.; Giuse, Dario A.; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K.

2011-01-01

Introduction: Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. Methods: We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. Results: We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Conclusion: Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations. PMID:22043185

Image dissemination and archiving.

PubMed

Robertson, Ian

2007-08-01

Images generated as part of the sonographic examination are an integral part of the medical record and must be retained according to local regulations. The standard medical image format, known as DICOM (Digital Imaging and COmmunications in Medicine) makes it possible for images from many different imaging modalities, including ultrasound, to be distributed via a standard internet network to distant viewing workstations and a central archive in an almost seamless fashion. The DICOM standard is a truly universal standard for the dissemination of medical images. When purchasing an ultrasound unit, the consumer should research the unit's capacity to generate images in a DICOM format, especially if one wishes interconnectivity with viewing workstations and an image archive that stores other medical images. PACS, an acronym for Picture Archive and Communication System refers to the infrastructure that links modalities, workstations, the image archive, and the medical record information system into an integrated system, allowing for efficient electronic distribution and storage of medical images and access to medical record data.

Integration of medical imaging into a multi-institutional hospital information system structure.

PubMed

Dayhoff, R E

1995-01-01

The Department of Veterans Affairs (VA) is providing integrated text and image data to its clinical users at its Washington and Baltimore medical centers and, soon, at nine other medical centers. The DHCP Imaging System records clinically significant diagnostic images selected by medical specialists in a variety of departments, including cardiology, gastroenterology, pathology, dermatology, surgery, radiology, podiatry, dentistry, and emergency medicine. These images, which include color and gray scale images, and electrocardiogram waveforms, are displayed on workstations located throughout the medical centers. Integration of clinical images with the VA's electronic mail system allows transfer of data from one medical center to another. The ability to incorporate transmitted text and image data into on-line patient records at the collaborating sites is an important aspect of professional consultation. In order to achieve the maximum benefits from an integrated patient record system, a critical mass of information must be available for clinicians. When there is also seamless support for administration, it becomes possible to re-engineer the processes involved in providing medical care.

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

PubMed Central

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

2012-01-01

Objective The use of electronic medical record (EMR) data is necessary to improve clinical research efficiency. However, it is not easy to identify patients who meet research eligibility criteria and collect the necessary information from EMRs because the data collection process must integrate various techniques, including the development of a data warehouse and translation of eligibility criteria into computable criteria. This research aimed to demonstrate an electronic medical records retrieval system (ERS) and an example of a hospital-based cohort study that identified both patients and exposure with an ERS. We also evaluated the feasibility and usefulness of the method. Design The system was developed and evaluated. Participants In total, 800 000 cases of clinical information stored in EMRs at our hospital were used. Primary and secondary outcome measures The feasibility and usefulness of the ERS, the method to convert text from eligible criteria to computable criteria, and a confirmation method to increase research data accuracy. Results To comprehensively and efficiently collect information from patients participating in clinical research, we developed an ERS. To create the ERS database, we designed a multidimensional data model optimised for patient identification. We also devised practical methods to translate narrative eligibility criteria into computable parameters. We applied the system to an actual hospital-based cohort study performed at our hospital and converted the test results into computable criteria. Based on this information, we identified eligible patients and extracted data necessary for confirmation by our investigators and for statistical analyses with our ERS. Conclusions We propose a pragmatic methodology to identify patients from EMRs who meet clinical research eligibility criteria. Our ERS allowed for the efficient collection of information on the eligibility of a given patient, reduced the labour required from the investigators and improved the reliability of the results. PMID:23117567

[A customized method for information extraction from unstructured text data in the electronic medical records].

PubMed

Bao, X Y; Huang, W J; Zhang, K; Jin, M; Li, Y; Niu, C Z

2018-04-18

There is a huge amount of diagnostic or treatment information in electronic medical record (EMR), which is a concrete manifestation of clinicians actual diagnosis and treatment details. Plenty of episodes in EMRs, such as complaints, present illness, past history, differential diagnosis, diagnostic imaging, surgical records, reflecting details of diagnosis and treatment in clinical process, adopt Chinese description of natural language. How to extract effective information from these Chinese narrative text data, and organize it into a form of tabular for analysis of medical research, for the practical utilization of clinical data in the real world, is a difficult problem in Chinese medical data processing. Based on the EMRs narrative text data in a tertiary hospital in China, a customized information extracting rules learning, and rule based information extraction methods is proposed. The overall method consists of three steps, which includes: (1) Step 1, a random sample of 600 copies (including the history of present illness, past history, personal history, family history, etc.) of the electronic medical record data, was extracted as raw corpora. With our developed Chinese clinical narrative text annotation platform, the trained clinician and nurses marked the tokens and phrases in the corpora which would be extracted (with a history of diabetes as an example). (2) Step 2, based on the annotated corpora clinical text data, some extraction templates were summarized and induced firstly. Then these templates were rewritten using regular expressions of Perl programming language, as extraction rules. Using these extraction rules as basic knowledge base, we developed extraction packages in Perl, for extracting data from the EMRs text data. In the end, the extracted data items were organized in tabular data format, for later usage in clinical research or hospital surveillance purposes. (3) As the final step of the method, the evaluation and validation of the proposed methods were implemented in the National Clinical Service Data Integration Platform, and we checked the extraction results using artificial verification and automated verification combined, proved the effectiveness of the method. For all the patients with diabetes as diagnosed disease in the Department of Endocrine in the hospital, the medical history episode of these patients showed that, altogether 1 436 patients were dismissed in 2015, and a history of diabetes medical records extraction results showed that the recall rate was 87.6%, the accuracy rate was 99.5%, and F-Score was 0.93. For all the 10% patients (totally 1 223 patients) with diabetes by the dismissed dates of August 2017 in the same department, the extracted diabetes history extraction results showed that the recall rate was 89.2%, the accuracy rate was 99.2%, F-Score was 0.94. This study mainly adopts the combination of natural language processing and rule-based information extraction, and designs and implements an algorithm for extracting customized information from unstructured Chinese electronic medical record text data. It has better results than existing work.

Using an Educational Electronic Documentation System to Help Nursing Students Accurately Identify Nursing Diagnoses

ERIC Educational Resources Information Center

Pobocik, Tamara J.

2013-01-01

The use of technology and electronic medical records in healthcare has exponentially increased. This quantitative research project used a pretest/posttest design, and reviewed how an educational electronic documentation system helped nursing students to identify the accurate related to statement of the nursing diagnosis for the patient in the case…

76 FR 64115 - Privacy Act of 1974; Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

...-leaf binders or file folders, and in electronic media, including NASA's Ethics Program Tracking System... documents, electronic media, micrographic media, photographs, or motion pictures film, and various medical....; General Accounting Office's General Policies/Procedures and Communications Manual, Chapter 7; Treasury...

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

PubMed

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

2016-01-01

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

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2011.

PubMed

Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

2012-05-01

Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists. Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic.

A study of the difference in volume of information in chief complaint and present illness between electronic and paper medical records.

PubMed

Boo, Yookyung; Noh, Young A; Kim, Min-gyung; Kim, Sukil

The introduction of an electronic medical record (EMR) has been rapidly accelerating in South Korea. The EMR was expected to improve quality of care, readability, availability, and the quality of data. However, the reluctance of healthcare providers to use the EMR may have caused a reduction of information recorded in EMRs. The purpose of this study was to identify whether there was any loss of information following the introduction of a narrative text-based EMR in the recording of chief complaint and present illness in inpatient medical records. Inpatient medical records of a university hospital were retrospectively evaluated for one month before and one month after the introduction of the EMR in June 2006. The volume of information for chief complaint and present illness was measured by number of words in Korean and normalised bytes. Change in volume of information was measured by two-way ANOVA and multiple regression analyses, controlling for doctors' gender, age, and grade/year of residents, patients' readmission status, reasons for admission and service department to assess any effect of the introduction of an EMR. Total numbers of paper-based medical records (PMRs) and EMRs for analysis were 1,159 and 1,122, respectively. Forty-three doctors participated in the study. Thirty-one (72%) doctors were less than 30 years of age. Number of words proved a better outcome measure (R²=22 for CC, R²=36 for PI) than normalised bytes (R²=18 for CC, R²=35 for PI) for measuring volume of information. Results showed that the volume of information in the chief complaint and present illness was not decreased after the introduction of the EMR, except when the dependent variable was measured by number of words in the present illness. The study showed that the introduction of the EMR did not reduce the volume of information documented for chief complaint and present illness in inpatient medical records. However, further studies are needed to identify how to control the probable loss of information as showed in present illness measured by number of words.

Medical record management systems: criticisms and new perspectives.

PubMed

Frénot, S; Laforest, F

1999-06-01

The first generation of computerized medical records stored the data as text, but these records did not bring any improvement in information manipulation. The use of a relational database management system (DBMS) has largely solved this problem as it allows for data requests by using SQL. However, this requires data structuring which is not very appropriate to medicine. Moreover, the use of templates and icon user interfaces has introduced a deviation from the paper-based record (still existing). The arrival of hypertext user interfaces has proven to be of interest to fill the gap between the paper-based medical record and its electronic version. We think that further improvement can be accomplished by using a fully document-based system. We present the architecture, advantages and disadvantages of classical DBMS-based and Web/DBMS-based solutions. We also present a document-based solution and explain its advantages, which include communication, security, flexibility and genericity.

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

PubMed Central

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

2014-01-01

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

Customizing clinical narratives for the electronic medical record interface using cognitive methods.

PubMed

Sharda, Pallav; Das, Amar K; Cohen, Trevor A; Patel, Vimla

2006-05-01

As healthcare practice transitions from paper-based to computer-based records, there is increasing need to determine an effective electronic format for clinical narratives. Our research focuses on utilizing a cognitive science methodology to guide the conversion of medical texts to a more structured, user-customized presentation in the electronic medical record (EMR). We studied the use of discharge summaries by psychiatrists with varying expertise-experts, intermediates, and novices. Experts were given two hypothetical emergency care scenarios with narrative discharge summaries and asked to verbalize their clinical assessment. Based on the results, the narratives were presented in a more structured form. Intermediate and novice subjects received a narrative and a structured discharge summary, and were asked to verbalize their assessments of each. A qualitative comparison of the interview transcripts of all subjects was done by analysis of recall and inference made with respect to level of expertise. For intermediate and novice subjects, recall was greater with the structured form than with the narrative. Novices were also able to make more inferences (not always accurate) from the structured form than with the narrative. Errors occurred in assessments using the narrative form but not the structured form. Our cognitive methods to study discharge summary use enabled us to extract a conceptual representation of clinical narratives from end-users. This method allowed us to identify clinically relevant information that can be used to structure medical text for the EMR and potentially improve recall and reduce errors.

Practical considerations to guide development of access controls and decision support for genetic information in electronic medical records.

PubMed

Darcy, Diana C; Lewis, Eleanor T; Ormond, Kelly E; Clark, David J; Trafton, Jodie A

2011-11-02

Genetic testing is increasingly used as a tool throughout the health care system. In 2011 the number of clinically available genetic tests is approaching 2,000, and wide variation exists between these tests in their sensitivity, specificity, and clinical implications, as well as the potential for discrimination based on the results. As health care systems increasingly implement electronic medical record systems (EMRs) they must carefully consider how to use information from this wide spectrum of genetic tests, with whom to share information, and how to provide decision support for clinicians to properly interpret the information. Although some characteristics of genetic tests overlap with other medical test results, there are reasons to make genetic test results widely available to health care providers and counterbalancing reasons to restrict access to these test results to honor patient preferences, and avoid distracting or confusing clinicians with irrelevant but complex information. Electronic medical records can facilitate and provide reasonable restrictions on access to genetic test results and deliver education and decision support tools to guide appropriate interpretation and use. This paper will serve to review some of the key characteristics of genetic tests as they relate to design of access control and decision support of genetic test information in the EMR, emphasizing the clear need for health information technology (HIT) to be part of optimal implementation of genetic medicine, and the importance of understanding key characteristics of genetic tests when designing HIT applications.

Evaluation of a Pilot Asthma Care Program for Electronic Communication between School Health and a Healthcare System's Electronic Medical Record.

PubMed

Reeves, Kelly W; Taylor, Yhenneko; Tapp, Hazel; Ludden, Thomas; Shade, Lindsay E; Burton, Beth; Courtlandt, Cheryl; Dulin, Michael

2016-10-19

Asthma is a common childhood chronic lung disease affecting greater than 10% of children in the United States. School nurses are in a unique position to close gaps in care. Indeed, effective asthma management is more likely to result when providers, family, and schools work together to optimize the patient's treatment plan. Currently, effective communication between schools and healthcare systems through electronic medical record (EMR) systems remains a challenge. The goal of this feasibility pilot was to link the school-based care team with primary care providers in the healthcare system network via electronic communication through the EMR, on behalf of pediatric asthma patients who had been hospitalized for an asthma exacerbation. The implementation process and the potential impact of the communication with providers on the reoccurrence of asthma exacerbations with the linked patients were evaluated. By engaging stakeholders from the school system and the healthcare system, we were able to collaboratively design a communication process and implement a pilot which demonstrated the feasibility of electronic communication between school nurses and primary care providers. Outcomes data was collected from the electronic medical record to examine the frequency of asthma exacerbations among patients with a message from their school nurse. The percent of exacerbations in the 12 months before and after electronic communication was compared using McNemar's test. The pilot system successfully established communication between the school nurse and primary care provider for 33 students who had been hospitalized for asthma and a decrease in hospital admissions was observed with students whose school nurse communicated through the EMR with the primary care provider. Findings suggest a collaborative model of care that is enhanced through electronic communication via the EMR could positively impact the health of children with asthma or other chronic illnesses.

Secure and Trustable Electronic Medical Records Sharing using Blockchain.

PubMed

Dubovitskaya, Alevtina; Xu, Zhigang; Ryu, Samuel; Schumacher, Michael; Wang, Fusheng

2017-01-01

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost.

Secure and Trustable Electronic Medical Records Sharing using Blockchain

PubMed Central

Dubovitskaya, Alevtina; Xu, Zhigang; Ryu, Samuel; Schumacher, Michael; Wang, Fusheng

2017-01-01

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost. PMID:29854130

Can a collaborative healthcare network improve the care of people with epilepsy?

PubMed

Shamim, Ejaz A; Mane, Ketan; Loddenkemper, Tobias; Leviton, Alan

2018-05-01

New opportunities are now available to improve care in ways not possible previously. Information contained in electronic medical records can now be shared without identifying patients. With network collaboration, large numbers of medical records can be searched to identify patients most like the one whose complex medical situation challenges the physician. The clinical effectiveness of different treatment strategies can be assessed rapidly to help the clinician decide on the best treatment for this patient. Other capabilities from different components of the network can prompt the recognition of what is the best available option and encourage the sharing of information about programs and electronic tools. Difficulties related to privacy, harmonization, integration, and costs are expected, but these are currently being addressed successfully by groups of organizations led by those who recognize the benefits. Copyright © 2018 Elsevier Inc. All rights reserved.

Electronic medical record features and seven quality of care measures in physician offices.

PubMed

Hsiao, Chun-Ju; Marsteller, Jill A; Simon, Alan E

2014-01-01

The effect of electronic medical records (EMRs) on quality of care in physicians' offices is uncertain. This study used the 2008-2009 National Ambulatory Medical Care Survey to examine the relationship between EMRs features and quality in physician offices. The relationship between selected EMRs features and 7 quality measures was evaluated by testing 25 associations in multivariate models. Significant relationships include reminders for guideline-based interventions or screening tests associated with lower odds of inappropriate urinalysis and prescription of antibiotics for upper respiratory infection (URI), prescription order entry associated with lower odds of prescription of antibiotics for URI, and patient problem list associated with higher odds of inappropriate prescribing for elderly patients. EMRs system level was associated with lower odds of blood pressure check, inappropriate urinalysis, and prescription of antibiotics for URI compared with no EMRs. The results show both positive and inverse relationships between EMRs features and quality of care.

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

PubMed Central

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

2006-01-01

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

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

PubMed

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

2006-01-01

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

Secure Dynamic access control scheme of PHR in cloud computing.

PubMed

Chen, Tzer-Shyong; Liu, Chia-Hui; Chen, Tzer-Long; Chen, Chin-Sheng; Bau, Jian-Guo; Lin, Tzu-Ching

2012-12-01

With the development of information technology and medical technology, medical information has been developed from traditional paper records into electronic medical records, which have now been widely applied. The new-style medical information exchange system "personal health records (PHR)" is gradually developed. PHR is a kind of health records maintained and recorded by individuals. An ideal personal health record could integrate personal medical information from different sources and provide complete and correct personal health and medical summary through the Internet or portable media under the requirements of security and privacy. A lot of personal health records are being utilized. The patient-centered PHR information exchange system allows the public autonomously maintain and manage personal health records. Such management is convenient for storing, accessing, and sharing personal medical records. With the emergence of Cloud computing, PHR service has been transferred to storing data into Cloud servers that the resources could be flexibly utilized and the operation cost can be reduced. Nevertheless, patients would face privacy problem when storing PHR data into Cloud. Besides, it requires a secure protection scheme to encrypt the medical records of each patient for storing PHR into Cloud server. In the encryption process, it would be a challenge to achieve accurately accessing to medical records and corresponding to flexibility and efficiency. A new PHR access control scheme under Cloud computing environments is proposed in this study. With Lagrange interpolation polynomial to establish a secure and effective PHR information access scheme, it allows to accurately access to PHR with security and is suitable for enormous multi-users. Moreover, this scheme also dynamically supports multi-users in Cloud computing environments with personal privacy and offers legal authorities to access to PHR. From security and effectiveness analyses, the proposed PHR access scheme in Cloud computing environments is proven flexible and secure and could effectively correspond to real-time appending and deleting user access authorization and appending and revising PHR records.

Implementing change in primary care practices using electronic medical records: a conceptual framework.

PubMed

Nemeth, Lynne S; Feifer, Chris; Stuart, Gail W; Ornstein, Steven M

2008-01-16

Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement.

From the front line, report from a near paperless hospital: mixed reception among health care professionals.

PubMed

Lium, Jan-Tore; Laerum, Hallvard; Schulz, Tom; Faxvaag, Arild

2006-01-01

Many Norwegian hospitals that are equipped with an electronic medical record (EMR) system now have proceeded to withdraw the paper-based medical record from clinical workflow. In two previous survey-based studies on the effect of removing the paper-based medical record on the work of physicians, nurses and medical secretaries, we concluded that to scan and eliminate the paper based record was feasible, but that the medical secretaries were the group that reported to benefit the most from the change. To further explore the effects of removing the paper based record, especially in regard to medical personnel, we now have conducted a follow up study of a hospital that has scanned and eliminated its paper-based record. A survey of 27 physicians, 60 nurses and 30 medical secretaries was conducted. The results were compared with those from a previous study conducted three years earlier at the same department. The questionnaire (see online Appendix) covered the frequency of use of the EMR system for specific tasks by physicians, nurses and medical secretaries, the ease of performing these tasks compared to previous routines, user satisfaction and computer literacy. Both physicians and nurses displayed increased use of the EMR compared to the previous study, while medical secretaries reported generally unchanged but high use. The increase in use was not accompanied by a similar change in factors such as computer literacy or technical changes, suggesting that these typical success factors are necessary but not sufficient.

Query Log Analysis of an Electronic Health Record Search Engine

PubMed Central

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. PMID:22195150

Electronic medical records in diabetes consultations: participants' gaze as an interactional resource.

PubMed

Rhodes, Penny; Small, Neil; Rowley, Emma; Langdon, Mark; Ariss, Steven; Wright, John

2008-09-01

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Infant feeding practices within a large electronic medical record database.

PubMed

Bartsch, Emily; Park, Alison L; Young, Jacqueline; Ray, Joel G; Tu, Karen

2018-01-02

The emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices. We completed a population-based retrospective cohort study of 8815 singleton infants born at term in Ontario, Canada, April 2002 to March 2013. Newborn records were linked to the Electronic Medical Record Administrative data Linked Database (EMRALD™), which uses patient-level information from participating family practice EMRs across Ontario. We assessed exclusive breastfeeding patterns using an automated electronic search algorithm, with manual review of EMRs when the latter was not possible. We examined the rate of breastfeeding at visits corresponding to 2, 4 and 6 months of age, as well as sociodemographic factors associated with exclusive breastfeeding. Of the 8815 newborns, 1044 (11.8%) lacked breastfeeding information in their EMR. Rates of exclusive breastfeeding were 39.5% at 2 months, 32.4% at 4 months and 25.1% at 6 months. At age 6 months, exclusive breastfeeding rates were highest among mothers aged ≥40 vs. < 20 years (rate ratio [RR] 2.45, 95% confidence interval [CI] 1.62-3.68), urban vs. rural residence (RR 1.35, 95% CI 1.22-1.50), and highest vs. lowest income quintile (RR 1.18, 95% CI 1.02-1.36). Overall, immigrants had similar rates of exclusive breastfeeding as non-immigrants; yet, by age 6 months, among those residing in the lowest income quintile, immigrants were more likely to exclusively breastfeed than their non-immigrant counterparts (RR 1.43, 95% CI 1.12-1.83). We efficiently determined rates and factors associated with exclusive breastfeeding using data from a large EMR database.

Using multi-stakeholder alliances to accelerate the adoption of health information technology by physician practices.

PubMed

McHugh, Megan; Shi, Yunfeng; McClellan, Sean R; Shortell, Stephen M; Fareed, Naleef; Harvey, Jillian; Ramsay, Patricia; Casalino, Lawrence P

2016-06-01

Multi-stakeholder alliances - groups of payers, purchasers, providers, and consumers that work together to address local health goals - are frequently used to improve health care quality within communities. Under the Aligning Forces for Quality (AF4Q) initiative, multi-stakeholder alliances were given funding and technical assistance to encourage the use of health information technology (HIT) to improve quality. We investigated whether HIT adoption was greater in AF4Q communities than in other communities. Drawing upon survey data from 782 small and medium-sized physician practices collected as part of the National Study of Physician Organizations during July 2007 - March 2009 and January 2012-November 2013, we used weighted fixed effects models to detect relative changes in four measures representing three domains: use of electronic health records (EHRs), receipt of electronic information from hospitals, and patients' online access to their medical records. Improvement on a composite EHR adoption measure was 7.6 percentage points greater in AF4Q communities than in non-AF4Q communities, and the increase in the probability of adopting all five EHR capabilities was 23.9 percentage points greater in AF4Q communities. There was no significant difference in improvement in receipt of electronic information from hospitals or patients' online access to medical records between AF4Q and non-AF4Q communities. By linking HIT to quality improvement efforts, AF4Q alliances may have facilitated greater adoption of EHRs in small and medium-sized physician practices, but not receipt of electronic information from hospitals or patients' online access to medical records. Multi-stakeholder alliances charged with promoting HIT to advance quality improvement may accelerate adoption of EHRs. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2009-07-01

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

A cloud-based framework for large-scale traditional Chinese medical record retrieval.

PubMed

Liu, Lijun; Liu, Li; Fu, Xiaodong; Huang, Qingsong; Zhang, Xianwen; Zhang, Yin

2018-01-01

Electronic medical records are increasingly common in medical practice. The secondary use of medical records has become increasingly important. It relies on the ability to retrieve the complete information about desired patient populations. How to effectively and accurately retrieve relevant medical records from large- scale medical big data is becoming a big challenge. Therefore, we propose an efficient and robust framework based on cloud for large-scale Traditional Chinese Medical Records (TCMRs) retrieval. We propose a parallel index building method and build a distributed search cluster, the former is used to improve the performance of index building, and the latter is used to provide high concurrent online TCMRs retrieval. Then, a real-time multi-indexing model is proposed to ensure the latest relevant TCMRs are indexed and retrieved in real-time, and a semantics-based query expansion method and a multi- factor ranking model are proposed to improve retrieval quality. Third, we implement a template-based visualization method for displaying medical reports. The proposed parallel indexing method and distributed search cluster can improve the performance of index building and provide high concurrent online TCMRs retrieval. The multi-indexing model can ensure the latest relevant TCMRs are indexed and retrieved in real-time. The semantics expansion method and the multi-factor ranking model can enhance retrieval quality. The template-based visualization method can enhance the availability and universality, where the medical reports are displayed via friendly web interface. In conclusion, compared with the current medical record retrieval systems, our system provides some advantages that are useful in improving the secondary use of large-scale traditional Chinese medical records in cloud environment. The proposed system is more easily integrated with existing clinical systems and be used in various scenarios. Copyright © 2017. Published by Elsevier Inc.

Building a portable data and information interoperability infrastructure-framework for a standard Taiwan Electronic Medical Record Template.

PubMed

Jian, Wen-Shan; Hsu, Chien-Yeh; Hao, Te-Hui; Wen, Hsyien-Chia; Hsu, Min-Huei; Lee, Yen-Liang; Li, Yu-Chuan; Chang, Polun

2007-11-01

Traditional electronic health record (EHR) data are produced from various hospital information systems. They could not have existed independently without an information system until the incarnation of XML technology. The interoperability of a healthcare system can be divided into two dimensions: functional interoperability and semantic interoperability. Currently, no single EHR standard exists that provides complete EHR interoperability. In order to establish a national EHR standard, we developed a set of local EHR templates. The Taiwan Electronic Medical Record Template (TMT) is a standard that aims to achieve semantic interoperability in EHR exchanges nationally. The TMT architecture is basically composed of forms, components, sections, and elements. Data stored in the elements which can be referenced by the code set, data type, and narrative block. The TMT was established with the following requirements in mind: (1) transformable to international standards; (2) having a minimal impact on the existing healthcare system; (3) easy to implement and deploy, and (4) compliant with Taiwan's current laws and regulations. The TMT provides a basis for building a portable, interoperable information infrastructure for EHR exchange in Taiwan.

Creating XML/PHP Interface for BAN Interoperability.

PubMed

Fragkos, Vasileios; Katzis, Konstantinos; Despotou, Georgios

2017-01-01

Recent advances in medical and electronic technologies have introduced the use of Body Area Networks as a part of e-health, for constant and accurate monitoring of patients and the transmission as well as processing of the data to develop a holistic Electronic Health Record. The rising global population, different BAN manufacturers and a variety of medical systems pose the issue of interoperability between BANs and systems as well as the proper way to propagate medical data in an organized and efficient manner. In this paper, we describe BANs and propose the use of certain web technologies to address this issue.

Building health information technology capacity: they may come but will they use it?

PubMed

Burke-Bebee, Suzie; Wilson, Marisa; Buckley, Kathleen M

2012-10-01

Medical errors remain a major safety problem more than a decade after the Institute of Medicine reported 98 000 related deaths occur yearly in US hospitals. Medication errors account for one-third of these errors. Although medication reconciliation is an accepted care standard for patient safety, little evidence is available to make practice recommendations for primary care. The purpose of this study was to evaluate the effectiveness of using secure e-mail alerts within the reconciliation process on patient medication safety in clinics where electronic and personal health records are used. A nonexperimental, descriptive design with a convenience sample of 62 patients from two Veterans Health Administration clinics was used. Patients received secure e-mail instructing them to review their online medication list, update it based on home medications, and bring it to the appointment for discussion with their provider. A retrospective chart review was conducted examining changes made to medication lists in the electronic record after reconciliation. Data revealed the organization's adoption of secure e-mail did not guarantee its meaningful use by providers and patients, a clear barrier to implementing technology as an adjunct to care in context of complex clinical processes such as medication reconciliation. Lessons learned from the project's implementation are discussed.

Transaction-neutral implanted data collection interface as EMR driver: a model for emerging distributed medical technologies.

PubMed

Lorence, Daniel; Sivaramakrishnan, Anusha; Richards, Michael

2010-08-01

Electronic Medical Record (EMR) and Electronic Health Record (EHR) adoption continues to lag across the US. Cost, inconsistent formats, and concerns about control of patient information are among the most common reasons for non-adoption in physician practice settings. The emergence of wearable and implanted mobile technologies, employed in distributed environments, promises a fundamentally different information infrastructure, which could serve to minimize existing adoption resistance. Proposed here is one technology model for overcoming adoption inconsistency and high organization-specific implementation costs, using seamless, patient controlled data collection. While the conceptual applications employed in this technology set are provided by way of illustration, they may also serve as a transformative model for emerging EMR/EHR requirements.

Change Management – Recommendations for Successful Electronic Medical Records Implementation

PubMed Central

Shoolin, J.S.

2010-01-01

Summary Change is difficult and managing change even more so. With the advent of Electronic Medical Records (EMRs) and the difficulty of its acceptance, understanding physician’s attitudes and the psychology of change management is imperative. While many authors describe change management theories, one comes nearest to describing this particularly difficult transition. In 1969, Elizabeth Kübler-Ross wrote her seminal treatise, On Death and Dying, detailing the psychological changes terminally ill patients undergo. Her grieving model is a template to examine the impact of change. By following a physician through the EMR maze, understanding the difficulties he/she perceives and developing a plan other change agents are able to use, the paper gives practical recommendations to EMR change management. PMID:23616842

Implementing and maintaining a researchable database from electronic medical records: a perspective from an academic family medicine department.

PubMed

Stewart, Moira; Thind, Amardeep; Terry, Amanda L; Chevendra, Vijaya; Marshall, J Neil

2009-11-01

Electronic medical records (EMRs) are posited as a tool for improving practice, policy and research in primary healthcare. This paper describes the Deliver Primary Healthcare Information (DELPHI) Project at the Department of Family Medicine at the University of Western Ontario, focusing on its development, current status and research potential in order to share experiences with researchers in similar contexts. The project progressed through four stages: (a) participant recruitment, (b) EMR software modification and implementation, (c) database creation and (d) data quality assessment. Currently, the DELPHI database holds more than two years of high-quality, de-identified data from 10 practices, with 30,000 patients and nearly a quarter of a million encounters.

The electronic, 'paperless' medical office; has it arrived?

PubMed

Gates, P; Urquhart, J

2007-02-01

Modern information technology offers efficiencies in medical practice, with a reduction in secretarial time in maintaining, filing and retrieving the paper medical record. Electronic requesting of investigations allows tracking of outstanding results. Less storage space is required and telephone calls from pharmacies, pathology and medical imaging service providers to clarify the hand-written request are abolished. Voice recognition software reduces secretarial typing time per letter. These combined benefits can lead to significantly reduced costs and improved patient care. The paperless office is possible, but requires commitment and training of all staff; it is preferable but not absolutely essential that at least one member of the practice has an interest and some expertise in computers. More importantly, back-up from information technology providers and back-up of the electronic data are absolutely crucial and a paperless environment should not be considered without them.

Characteristics of personal health records: findings of the Medical Library Association/National Library of Medicine Joint Electronic Personal Health Record Task Force.

PubMed

Jones, Dixie A; Shipman, Jean P; Plaut, Daphne A; Selden, Catherine R

2010-07-01

The Medical Library Association (MLA)/National Library of Medicine (NLM) Joint Electronic Personal Health Record Task Force examined the current state of personal health records (PHRs). A working definition of PHRs was formulated, and a database was built with fields for specified PHR characteristics. PHRs were identified and listed. Each task force member was assigned a portion of the list for data gathering. Findings were recorded in the database. Of the 117 PHRs identified, 91 were viable. Almost half were standalone products. A number used national standards for nomenclature and/or record structure. Less than half were mobile device enabled. Some were publicly available, and others were offered only to enrollees of particular health plans or employees at particular institutions. A few were targeted to special health conditions. The PHR field is very dynamic. While most PHR products have some common elements, their features can vary. PHRs can link their users with librarians and information resources. MLA and NLM have taken an active role in making this connection and in encouraging librarians to assume this assistance role with PHRs.

Data-driven approach for creating synthetic electronic medical records.

PubMed

Buczak, Anna L; Babin, Steven; Moniz, Linda

2010-10-14

New algorithms for disease outbreak detection are being developed to take advantage of full electronic medical records (EMRs) that contain a wealth of patient information. However, due to privacy concerns, even anonymized EMRs cannot be shared among researchers, resulting in great difficulty in comparing the effectiveness of these algorithms. To bridge the gap between novel bio-surveillance algorithms operating on full EMRs and the lack of non-identifiable EMR data, a method for generating complete and synthetic EMRs was developed. This paper describes a novel methodology for generating complete synthetic EMRs both for an outbreak illness of interest (tularemia) and for background records. The method developed has three major steps: 1) synthetic patient identity and basic information generation; 2) identification of care patterns that the synthetic patients would receive based on the information present in real EMR data for similar health problems; 3) adaptation of these care patterns to the synthetic patient population. We generated EMRs, including visit records, clinical activity, laboratory orders/results and radiology orders/results for 203 synthetic tularemia outbreak patients. Validation of the records by a medical expert revealed problems in 19% of the records; these were subsequently corrected. We also generated background EMRs for over 3000 patients in the 4-11 yr age group. Validation of those records by a medical expert revealed problems in fewer than 3% of these background patient EMRs and the errors were subsequently rectified. A data-driven method was developed for generating fully synthetic EMRs. The method is general and can be applied to any data set that has similar data elements (such as laboratory and radiology orders and results, clinical activity, prescription orders). The pilot synthetic outbreak records were for tularemia but our approach may be adapted to other infectious diseases. The pilot synthetic background records were in the 4-11 year old age group. The adaptations that must be made to the algorithms to produce synthetic background EMRs for other age groups are indicated.

Are electronic medical records helpful for care coordination? Experiences of physician practices.

PubMed

O'Malley, Ann S; Grossman, Joy M; Cohen, Genna R; Kemper, Nicole M; Pham, Hoangmai H

2010-03-01

Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-around practices have created to address new coordination challenges. Semi-structured telephone interviews in 12 randomly selected communities. Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity). There is a gap between policy-makers' expectation of, and clinical practitioners' experience with, current electronic medical records' ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

User-Centered Design, Experience, and Usability of an Electronic Consent User Interface to Facilitate Informed Decision-Making in an HIV Clinic.

PubMed

Ramos, S Raquel

2017-11-01

Health information exchange is the electronic accessibility and transferability of patient medical records across various healthcare settings and providers. In some states, patients have to formally give consent to allow their medical records to be electronically shared. The purpose of this study was to apply a novel user-centered, multistep, multiframework approach to design and test an electronic consent user interface, so patients with HIV can make more informed decisions about electronically sharing their health information. This study consisted of two steps. Step 1 was a cross-sectional, descriptive, qualitative study that used user-centric design interviews to create the user interface. This informed Step 2. Step 2 consisted of a one group posttest to examine perceptions of usefulness, ease of use, preference, and comprehension of a health information exchange electronic consent user interface. More than half of the study population had college experience, but challenges remained with overall comprehension regarding consent. The user interface was not independently successful, suggesting that in addition to an electronic consent user interface, human interaction may also be necessary to address the complexities associated with consenting to electronically share health information. Comprehension is key factor in the ability to make informed decisions.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

PubMed

Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

2009-10-08

Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support

PubMed Central

2009-01-01

Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment. PMID:19814826

Optimizing the electronic health record to standardize administration and documentation of nutritional supplements

PubMed Central

Citty, Sandra W.; Kamel, Amir; Garvan, Cynthia; Marlowe, Lee; Westhoff, Lynn

2017-01-01

Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct type, amount and frequency of nutritional products (p=0.0001). ENAR represented an effective strategy to improve administration and documentation of nutritional supplements for hospitalized patients. PMID:28243439

Optimizing the electronic health record to standardize administration and documentation of nutritional supplements.

PubMed

Citty, Sandra W; Kamel, Amir; Garvan, Cynthia; Marlowe, Lee; Westhoff, Lynn

2017-01-01

Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct type, amount and frequency of nutritional products (p=0.0001). ENAR represented an effective strategy to improve administration and documentation of nutritional supplements for hospitalized patients.

Taking note of the perceived value and impact of medical student chart documentation on education and patient care.

PubMed

Friedman, Erica; Sainte, Michelle; Fallar, Robert

2010-09-01

To determine the extent of restrictions to medical student documentation in patients' records and the opinions of medical education leaders about such restrictions' impact on medical student education and patient care. Education deans (n = 126) of medical schools in the United States and Canada were surveyed to determine policies regarding placement of medical student notes in the patient record, the value of medical students' documentation in the medical record, and the use of electronic medical records (EMRs) for patient notes. The instrument was a 23-item anonymous Web survey. Seventy-nine deans responded. Over 90% believed student notes belong in medical records, but only 42% had a policy regarding this. Ninety-three percent indicated that without student notes, student education would be negatively affected. Fewer (56%) indicated that patient care would be negatively affected. Most thought limiting students' notes would negatively affect several other issues: feeling a part of the team (96%), preparation for internship (95%), and students' sense of involvement (94%). Half (52%) reported that fourth-year students could place notes in paper charts at "all" affiliated hospitals, and 6% reported that fourth-year students could do so at "no" hospitals. Although students' ability to enter notes in patients' records is believed to be important for student education, only about half of all hospitals allow all students' notes in the EMR. Policies regarding placement of student notes should be implemented to ensure students' competency in note writing and their value as members of the patient care team.

78 FR 10610 - TRICARE; Demonstration Project for Participation in Maryland Multi-Payer Patient Centered Medical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-14

... evidence-based medicine; use of electronic medical records; care coordination; care transition management... be weighted based on practice size, practice share of Maryland based TRICARE beneficiaries and.... TRICARE Prime and Standard beneficiaries will be assigned/attributed to the MMPCMHP demonstration based on...

Identifying Patients for Clinical Studies from Electronic Health Records: TREC 2012 Medical Records Track at OHSU

DTIC Science & Technology

2012-11-01

causes of hypertension ") AND NOT(report_text:"pulmonary| portal hypertension " OR report_text:"secondary to hypertension ") 182 Patients with Ischemic... hypertension , and tachycardia (discharge_icd_codes_txt:293.0 OR report_text:delirium) AND (discharge_icd_codes_txt:401.* OR discharge_icd_codes_txt:405...report_text:"**AGE[in teens") 162 Patients with hypertension on anti- hypertensive medication (report_text:" hypertension " OR report_text:"high blood

Distributed telemedicine for the National Information Infrastructure

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

Forslund, D.W.; Lee, Seong H.; Reverbel, F.C.

1997-08-01

TeleMed is an advanced system that provides a distributed multimedia electronic medical record available over a wide area network. It uses object-based computing, distributed data repositories, advanced graphical user interfaces, and visualization tools along with innovative concept extraction of image information for storing and accessing medical records developed in a separate project from 1994-5. In 1996, we began the transition to Java, extended the infrastructure, and worked to begin deploying TeleMed-like technologies throughout the nation. Other applications are mentioned.

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

PubMed

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

2011-08-01

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

We Work with Them? Healthcare Workers Interpretation of Organizational Relations Mined from Electronic Health Records

PubMed Central

Chen, You; Lorenzi, Nancy; Nyemba, Steve; Schildcrout, Jonathan S.; Malin, Bradley

2014-01-01

Objective Models of healthcare organizations (HCOs) are often defined up front by a select few administrative officials and managers. However, given the size and complexity of modern healthcare systems, this practice does not scale easily. The goal of this work is to investigate the extent to which organizational relationships can be automatically learned from utilization patterns of electronic health record (EHR) systems. Method We designed an online survey to solicit the perspectives of employees of a large academic medical center. We surveyed employees from two administrative areas: 1) Coding & Charge Entry and 2) Medical Information Services and two clinical areas: 3) Anesthesiology and 4) Psychiatry. To test our hypotheses we selected two administrative units that have work-related responsibilities with electronic records; however, for the clinical areas we selected two disciplines with very different patient responsibilities and whose accesses and people who accessed were similar. We provided each group of employees with questions regarding the chance of interaction between areas in the medical center in the form of association rules (e.g., Given someone from Coding & Charge Entry accessed a patient’s record, what is the chance that someone from Medical Information Services access the same record?). We compared the respondent predictions with the rules learned from actual EHR utilization using linear-mixed effects regression models. Results The findings from our survey confirm that medical center employees can distinguish between association rules of high and non-high likelihood when their own area is involved. Moreover, they can make such distinctions between for any HCO area in this survey. It was further observed that, with respect to highly likely interactions, respondents from certain areas were significantly better than other respondents at making such distinctions and certain areas’ associations were more distinguishable than others. Conclusions These results illustrate that EHR utilization patterns may be consistent with the expectations of HCO employees. Our findings show that certain areas in the HCO are easier than others for employees to assess, which suggests that automated learning strategies may yield more accurate models of healthcare organizations than those based on the perspectives of a select few individuals. PMID:24845147

Possible designs of medication monitors. Final report

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

Moulding, T.S.

A medication monitor is a device which utilizes radioactive material and photographic film to determine when patients remove medication from a dispenser. The material presents multiple, largely mechanical, ideas for making this type of dispenser so it can be used for a wide range of medication regimens. The description includes using the idea of a digital clock and memory chips for the time recording system. It also includes details on (1) choice of radioactive source and method of sealing source, (2) methods of locking or sealing medication monitors, (3) detailed instructions for using existing devices, (4) a simplified film developmentmore » system, (5) a mechanical and electronic means for creating a dispenser to reduce the chance of suicidal overdosage, and (6) an electronic means to allow a patient to compensate for medication forgotten without taking an excessive dose of medication.« less

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2012-01-01

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

Quality of nursing documentation: Paper-based health records versus electronic-based health records.

PubMed

Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam

2018-02-01

To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes. © 2017 John Wiley & Sons Ltd.

A Development of Automatic Audit System for Written Informed Consent using Machine Learning.

PubMed

Yamada, Hitomi; Takemura, Tadamasa; Asai, Takahiro; Okamoto, Kazuya; Kuroda, Tomohiro; Kuwata, Shigeki

2015-01-01

In Japan, most of all the university and advanced hospitals have implemented both electronic order entry systems and electronic charting. In addition, all medical records are subjected to inspector audit for quality assurance. The record of informed consent (IC) is very important as this provides evidence of consent from the patient or patient's family and health care provider. Therefore, we developed an automatic audit system for a hospital information system (HIS) that is able to evaluate IC automatically using machine learning.

Statistical Relational Learning to Predict Primary Myocardial Infarction from Electronic Health Records

PubMed Central

Weiss, Jeremy C; Page, David; Peissig, Peggy L; Natarajan, Sriraam; McCarty, Catherine

2013-01-01

Electronic health records (EHRs) are an emerging relational domain with large potential to improve clinical outcomes. We apply two statistical relational learning (SRL) algorithms to the task of predicting primary myocardial infarction. We show that one SRL algorithm, relational functional gradient boosting, outperforms propositional learners particularly in the medically-relevant high recall region. We observe that both SRL algorithms predict outcomes better than their propositional analogs and suggest how our methods can augment current epidemiological practices. PMID:25360347

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

PubMed

Omatsu, Masahiko; Tachibana, Hidenobu; Umeda, Tokuo

2004-06-01

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

Geographic Information Systems to Assess External Validity in Randomized Trials.

PubMed

Savoca, Margaret R; Ludwig, David A; Jones, Stedman T; Jason Clodfelter, K; Sloop, Joseph B; Bollhalter, Linda Y; Bertoni, Alain G

2017-08-01

To support claims that RCTs can reduce health disparities (i.e., are translational), it is imperative that methodologies exist to evaluate the tenability of external validity in RCTs when probabilistic sampling of participants is not employed. Typically, attempts at establishing post hoc external validity are limited to a few comparisons across convenience variables, which must be available in both sample and population. A Type 2 diabetes RCT was used as an example of a method that uses a geographic information system to assess external validity in the absence of a priori probabilistic community-wide diabetes risk sampling strategy. A geographic information system, 2009-2013 county death certificate records, and 2013-2014 electronic medical records were used to identify community-wide diabetes prevalence. Color-coded diabetes density maps provided visual representation of these densities. Chi-square goodness of fit statistic/analysis tested the degree to which distribution of RCT participants varied across density classes compared to what would be expected, given simple random sampling of the county population. Analyses were conducted in 2016. Diabetes prevalence areas as represented by death certificate and electronic medical records were distributed similarly. The simple random sample model was not a good fit for death certificate record (chi-square, 17.63; p=0.0001) and electronic medical record data (chi-square, 28.92; p<0.0001). Generally, RCT participants were oversampled in high-diabetes density areas. Location is a highly reliable "principal variable" associated with health disparities. It serves as a directly measurable proxy for high-risk underserved communities, thus offering an effective and practical approach for examining external validity of RCTs. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Digital radiography and electronic data storage from the perspective of legal requirements for record keeping.

PubMed

Figgener, L; Runte, C

2003-12-01

In some countries physicians and dentists are required by law to keep medical and dental records. These records not only serve as personal notes and memory aids but have to be in accordance with the necessary standard of care and may be used as evidence in litigation. Inadequate, incomplete or even missing records can lead to reversal of the burden of proof, resulting in a dramatically reduced chance of successful defence in litigation. The introduction of digital radiography and electronic data storage presents a new problem with respect to legal evidence, since digital data can easily be manipulated and industry is now required to provide adequate measures to prevent manipulations and forgery.

Using data from ambient assisted living and smart homes in electronic health records.

PubMed

Knaup, P; Schöpe, L

2014-01-01

This editorial is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". To increase efficiency in the health care of the future, data from innovative technology like it is used for ambient assisted living (AAL) or smart homes should be available for individual health decisions. Integrating and aggregating data from different medical devices and health records enables a comprehensive view on health data. The objective of this paper is to present examples of the state of the art in research on information management that leads to a sustainable use and long-term storage of health data provided by innovative assistive technologies in daily living. Current research deals with the perceived usefulness of sensor data, the participatory design of visual displays for presenting monitoring data, and communication architectures for integrating sensor data from home health care environments with health care providers either via a regional health record bank or via a telemedical center. Integrating data from AAL systems and smart homes with data from electronic patient or health records is still in an early stage. Several projects are in an advanced conceptual phase, some of them exploring feasibility with the help of prototypes. General comprehensive solutions are hardly available and should become a major issue of medical informatics research in the near future.

Using High-Technology Simulators to Prepare Anesthesia Providers Before Implementation of a New Electronic Health Record Module: A Technical Report.

PubMed

Weintraub, Ari Y; Deutsch, Ellen S; Hales, Roberta L; Buchanan, Newton A; Rock, Whitney L; Rehman, Mohamed A

2017-06-01

Learning to use a new electronic anesthesia information management system can be challenging. Documenting anesthetic events, medication administration, and airway management in an unfamiliar system while simultaneously caring for a patient with the vigilance required for safe anesthesia can be distracting and risky. This technical report describes a vendor-agnostic approach to training using a high-technology manikin in a simulated clinical scenario. Training was feasible and valued by participants but required a combination of electronic and manual components. Further exploration may reveal simulated patient care training that provides the greatest benefit to participants as well as feedback to inform electronic health record improvements.

Mining free-text medical records for companion animal enteric syndrome surveillance.

PubMed

Anholt, R M; Berezowski, J; Jamal, I; Ribble, C; Stephen, C

2014-03-01

Large amounts of animal health care data are present in veterinary electronic medical records (EMR) and they present an opportunity for companion animal disease surveillance. Veterinary patient records are largely in free-text without clinical coding or fixed vocabulary. Text-mining, a computer and information technology application, is needed to identify cases of interest and to add structure to the otherwise unstructured data. In this study EMR's were extracted from veterinary management programs of 12 participating veterinary practices and stored in a data warehouse. Using commercially available text-mining software (WordStat™), we developed a categorization dictionary that could be used to automatically classify and extract enteric syndrome cases from the warehoused electronic medical records. The diagnostic accuracy of the text-miner for retrieving cases of enteric syndrome was measured against human reviewers who independently categorized a random sample of 2500 cases as enteric syndrome positive or negative. Compared to the reviewers, the text-miner retrieved cases with enteric signs with a sensitivity of 87.6% (95%CI, 80.4-92.9%) and a specificity of 99.3% (95%CI, 98.9-99.6%). Automatic and accurate detection of enteric syndrome cases provides an opportunity for community surveillance of enteric pathogens in companion animals. Copyright © 2014 Elsevier B.V. All rights reserved.

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. Copyright © 2014 Elsevier Inc. All rights reserved.

A novel clinical decision support algorithm for constructing complete medication histories.

PubMed

Long, Ju; Yuan, Michael Juntao

2017-07-01

A patient's complete medication history is a crucial element for physicians to develop a full understanding of the patient's medical conditions and treatment options. However, due to the fragmented nature of medical data, this process can be very time-consuming and often impossible for physicians to construct a complete medication history for complex patients. In this paper, we describe an accurate, computationally efficient and scalable algorithm to construct a medication history timeline. The algorithm is developed and validated based on 1 million random prescription records from a large national prescription data aggregator. Our evaluation shows that the algorithm can be scaled horizontally on-demand, making it suitable for future delivery in a cloud-computing environment. We also propose that this cloud-based medication history computation algorithm could be integrated into Electronic Medical Records, enabling informed clinical decision-making at the point of care. Copyright © 2017 Elsevier B.V. All rights reserved.

Modelling Medications for Public Health Research

PubMed Central

van Gaans, D.; Ahmed, S.; D’Onise, K.; Moyon, J.; Caughey, G.; McDermott, R.

2016-01-01

Most patients with chronic disease are prescribed multiple medications, which are recorded in their personal health records. This is rich information for clinical public health researchers but also a challenge to analyse. This paper describes the method that was undertaken within the Public Health Research Data Management System (PHReDMS) to map medication data retrieved from individual patient health records for population health researcher’s use. The PHReDMS manages clinical, health service, community and survey research data within a secure web environment that allows for data sharing amongst researchers. The PHReDMS is currently used by researchers to answer a broad range of questions, including monitoring of prescription patterns in different population groups and geographic areas with high incidence/prevalence of chronic renal, cardiovascular, metabolic and mental health issues. In this paper, we present the general notion of abstraction network, a higher level network that sits above a terminology and offers compact and more easily understandable view of its content. We demonstrate the utilisation of abstraction network methodology to examine medication data from electronic medical records to allow a compact and more easily understandable view of its content. PMID:28149446

Validation of an association rule mining-based method to infer associations between medications and problems.

PubMed

Wright, A; McCoy, A; Henkin, S; Flaherty, M; Sittig, D

2013-01-01

In a prior study, we developed methods for automatically identifying associations between medications and problems using association rule mining on a large clinical data warehouse and validated these methods at a single site which used a self-developed electronic health record. To demonstrate the generalizability of these methods by validating them at an external site. We received data on medications and problems for 263,597 patients from the University of Texas Health Science Center at Houston Faculty Practice, an ambulatory practice that uses the Allscripts Enterprise commercial electronic health record product. We then conducted association rule mining to identify associated pairs of medications and problems and characterized these associations with five measures of interestingness: support, confidence, chi-square, interest and conviction and compared the top-ranked pairs to a gold standard. 25,088 medication-problem pairs were identified that exceeded our confidence and support thresholds. An analysis of the top 500 pairs according to each measure of interestingness showed a high degree of accuracy for highly-ranked pairs. The same technique was successfully employed at the University of Texas and accuracy was comparable to our previous results. Top associations included many medications that are highly specific for a particular problem as well as a large number of common, accurate medication-problem pairs that reflect practice patterns.

Use of Electronic Medical Record–Enhanced Checklist and Electronic Dashboard to Decrease CLABSIs

PubMed Central

Longhurst, Christopher A.; Wood, Matthew; Cornfield, David N.; Suermondt, Jaap; Sharek, Paul J.; Franzon, Deborah

2014-01-01

OBJECTIVES: We hypothesized that a checklist enhanced by the electronic medical record and a unit-wide dashboard would improve compliance with an evidence-based, pediatric-specific catheter care bundle and decrease central line–associated bloodstream infections (CLABSI). METHODS: We performed a cohort study with historical controls that included all patients with a central venous catheter in a 24-bed PICU in an academic children’s hospital. Postintervention CLABSI rates, compliance with bundle elements, and staff perceptions of communication were evaluated and compared with preintervention data. RESULTS: CLABSI rates decreased from 2.6 CLABSIs per 1000 line-days before intervention to 0.7 CLABSIs per 1000 line-days after intervention. Analysis of specific bundle elements demonstrated increased daily documentation of line necessity from 30% to 73% (P < .001), increased compliance with dressing changes from 87% to 90% (P = .003), increased compliance with cap changes from 87% to 93% (P < .001), increased compliance with port needle changes from 69% to 95% (P < .001), but decreased compliance with insertion bundle documentation from 67% to 62% (P = .001). Changes in the care plan were made during review of the electronic medical record checklist on 39% of patient rounds episodes. CONCLUSIONS: Use of an electronic medical record–enhanced CLABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidence-based catheter care and sustained decrease in CLABSI rates. These data underscore the potential for computerized interventions to promote compliance with proven best practices and prevent patient harm. PMID:24567021

Efficient Queries of Stand-off Annotations for Natural Language Processing on Electronic Medical Records.

PubMed

Luo, Yuan; Szolovits, Peter

2016-01-01

In natural language processing, stand-off annotation uses the starting and ending positions of an annotation to anchor it to the text and stores the annotation content separately from the text. We address the fundamental problem of efficiently storing stand-off annotations when applying natural language processing on narrative clinical notes in electronic medical records (EMRs) and efficiently retrieving such annotations that satisfy position constraints. Efficient storage and retrieval of stand-off annotations can facilitate tasks such as mapping unstructured text to electronic medical record ontologies. We first formulate this problem into the interval query problem, for which optimal query/update time is in general logarithm. We next perform a tight time complexity analysis on the basic interval tree query algorithm and show its nonoptimality when being applied to a collection of 13 query types from Allen's interval algebra. We then study two closely related state-of-the-art interval query algorithms, proposed query reformulations, and augmentations to the second algorithm. Our proposed algorithm achieves logarithmic time stabbing-max query time complexity and solves the stabbing-interval query tasks on all of Allen's relations in logarithmic time, attaining the theoretic lower bound. Updating time is kept logarithmic and the space requirement is kept linear at the same time. We also discuss interval management in external memory models and higher dimensions.

Efficient Queries of Stand-off Annotations for Natural Language Processing on Electronic Medical Records

PubMed Central

Luo, Yuan; Szolovits, Peter

2016-01-01

In natural language processing, stand-off annotation uses the starting and ending positions of an annotation to anchor it to the text and stores the annotation content separately from the text. We address the fundamental problem of efficiently storing stand-off annotations when applying natural language processing on narrative clinical notes in electronic medical records (EMRs) and efficiently retrieving such annotations that satisfy position constraints. Efficient storage and retrieval of stand-off annotations can facilitate tasks such as mapping unstructured text to electronic medical record ontologies. We first formulate this problem into the interval query problem, for which optimal query/update time is in general logarithm. We next perform a tight time complexity analysis on the basic interval tree query algorithm and show its nonoptimality when being applied to a collection of 13 query types from Allen’s interval algebra. We then study two closely related state-of-the-art interval query algorithms, proposed query reformulations, and augmentations to the second algorithm. Our proposed algorithm achieves logarithmic time stabbing-max query time complexity and solves the stabbing-interval query tasks on all of Allen’s relations in logarithmic time, attaining the theoretic lower bound. Updating time is kept logarithmic and the space requirement is kept linear at the same time. We also discuss interval management in external memory models and higher dimensions. PMID:27478379

A secure medical data exchange protocol based on cloud environment.

PubMed

Chen, Chin-Ling; Yang, Tsai-Tung; Shih, Tzay-Farn

2014-09-01

In recent years, health care technologies already became matured such as electronic medical records that can be easily stored. However, how to get medical resources more convenient is currently concern issue. In spite of many literatures discussed about medical systems, but these literatures should face many security challenges. The most important issue is patients' privacy. Therefore, we propose a secure medical data exchange protocol based on cloud environment. In our scheme, we use mobile device's characteristics, allowing peoples use medical resources on the cloud environment to seek medical advice conveniently.

Advanced Patient Data Replication and Recovery

DTIC Science & Technology

2010-10-01

Patient Data Protection (APDAPT) Eisenhower Medical Center (EMC) is attempting to lower the risk of losing patient data, as well as the risk...includes radiological images. EMC has made a multi-million dollar investment in the digitization of patient data; the Electronic Medical Record (EMR...storage and retrieval of the patient chart or EMR. The EMR is comprised of patient vital signs, nurse notes, medications administered, doctors

Self-adhesive epidermal carbon nanotube electronics for tether-free long-term continuous recording of biosignals

NASA Astrophysics Data System (ADS)

Lee, Seung Min; Byeon, Hang Jin; Lee, Joong Hoon; Baek, Dong Hyun; Lee, Kwang Ho; Hong, Joung Sook; Lee, Sang-Hoon

2014-08-01

The long-term, continuous, inconspicuous, and noiseless monitoring of bioelectrical signals is critical to the early diagnosis of disease and monitoring health and wellbeing. However, it is a major challenge to record the bioelectrical signals of patients going about their daily lives because of the difficulties of integrating skin-like conducting materials, the measuring system, and medical technologies in a single platform. In this study, we developed a thin epidermis-like electronics that is capable of repeated self-adhesion onto skin, integration with commercial electronic components through soldering, and conformal contact without serious motion artifacts. Using well-mixed carbon nanotubes and adhesive polydimethylsiloxane, we fabricated an epidermal carbon nanotube electronics which maintains excellent conformal contact even within wrinkles in skin, and can be used to record electrocardiogram signals robustly. The electrode is biocompatible and can even be operated in water, which means patients can live normal lives despite wearing a complicated recording system.

Self-adhesive epidermal carbon nanotube electronics for tether-free long-term continuous recording of biosignals

PubMed Central

Lee, Seung Min; Byeon, Hang Jin; Lee, Joong Hoon; Baek, Dong Hyun; Lee, Kwang Ho; Hong, Joung Sook; Lee, Sang-Hoon

2014-01-01

The long-term, continuous, inconspicuous, and noiseless monitoring of bioelectrical signals is critical to the early diagnosis of disease and monitoring health and wellbeing. However, it is a major challenge to record the bioelectrical signals of patients going about their daily lives because of the difficulties of integrating skin-like conducting materials, the measuring system, and medical technologies in a single platform. In this study, we developed a thin epidermis-like electronics that is capable of repeated self-adhesion onto skin, integration with commercial electronic components through soldering, and conformal contact without serious motion artifacts. Using well-mixed carbon nanotubes and adhesive polydimethylsiloxane, we fabricated an epidermal carbon nanotube electronics which maintains excellent conformal contact even within wrinkles in skin, and can be used to record electrocardiogram signals robustly. The electrode is biocompatible and can even be operated in water, which means patients can live normal lives despite wearing a complicated recording system. PMID:25123356

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

PubMed

Fragidis, Leonidas L; Chatzoglou, Prodromos D; Aggelidis, Vassilios P

2016-11-14

The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

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

NASA Astrophysics Data System (ADS)

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

2003-05-01

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

Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record.

PubMed

Wright, Adam; Sittig, Dean F; McGowan, Julie; Ash, Joan S; Weed, Lawrence L

2014-01-01

Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software--over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Impact of electronic order management on the timeliness of antibiotic administration in critical care patients.

PubMed

Cartmill, Randi S; Walker, James M; Blosky, Mary Ann; Brown, Roger L; Djurkovic, Svetolik; Dunham, Deborah B; Gardill, Debra; Haupt, Marilyn T; Parry, Dean; Wetterneck, Tosha B; Wood, Kenneth E; Carayon, Pascale

2012-11-01

To examine the effect of implementing electronic order management on the timely administration of antibiotics to critical-care patients. We used a prospective pre-post design, collecting data on first-dose IV antibiotic orders before and after the implementation of an integrated electronic medication-management system, which included computerized provider order entry (CPOE), pharmacy order processing and an electronic medication administration record (eMAR). The research was performed in a 24-bed adult medical/surgical ICU in a large, rural, tertiary medical center. Data on the time of ordering, pharmacy processing and administration were prospectively collected and time intervals for each stage and the overall process were calculated. The overall turnaround time from ordering to administration significantly decreased from a median of 100 min before order management implementation to a median of 64 min after implementation. The first part of the medication use process, i.e., from order entry to pharmacy processing, improved significantly whereas no change was observed in the phase from pharmacy processing to medication administration. The implementation of an electronic order-management system improved the timeliness of antibiotic administration to critical-care patients. Additional system changes are required to further decrease the turnaround time. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Predicting healthcare trajectories from medical records: A deep learning approach.

PubMed

Pham, Trang; Tran, Truyen; Phung, Dinh; Venkatesh, Svetha

2017-05-01

Personalized predictive medicine necessitates the modeling of patient illness and care processes, which inherently have long-term temporal dependencies. Healthcare observations, stored in electronic medical records are episodic and irregular in time. We introduce DeepCare, an end-to-end deep dynamic neural network that reads medical records, stores previous illness history, infers current illness states and predicts future medical outcomes. At the data level, DeepCare represents care episodes as vectors and models patient health state trajectories by the memory of historical records. Built on Long Short-Term Memory (LSTM), DeepCare introduces methods to handle irregularly timed events by moderating the forgetting and consolidation of memory. DeepCare also explicitly models medical interventions that change the course of illness and shape future medical risk. Moving up to the health state level, historical and present health states are then aggregated through multiscale temporal pooling, before passing through a neural network that estimates future outcomes. We demonstrate the efficacy of DeepCare for disease progression modeling, intervention recommendation, and future risk prediction. On two important cohorts with heavy social and economic burden - diabetes and mental health - the results show improved prediction accuracy. Copyright © 2017 Elsevier Inc. All rights reserved.

Electronic consent channels: preserving patient privacy without handcuffing researchers.

PubMed

Shelton, Robert H

2011-02-09

Advances in health information technology and electronic medical records have the tremendous potential to accelerate translational and clinical research. However, privacy concerns threaten to be a rate-limiting factor. By recognizing and responding to patient privacy concerns, policy-makers, researchers, and information technology leaders have the opportunity to transform trial recruitment and make it safer to electronically locate and convey sensitive health information.

The clinical information system GastroBase: integration of image processing and laboratory communication.

PubMed

Kocna, P

1995-01-01

GastroBase, a clinical information system, incorporates patient identification, medical records, images, laboratory data, patient history, physical examination, and other patient-related information. Program modules are written in C; all data is processed using Novell-Btrieve data manager. Patient identification database represents the main core of this information systems. A graphic library developed in the past year and graphic modules with a special video-card enables the storing, archiving, and linking of different images to the electronic patient-medical-record. GastroBase has been running for more than four years in daily routine and the database contains more than 25,000 medical records and 1,500 images. This new version of GastroBase is now incorporated into the clinical information system of University Clinic in Prague.

Extracting Sexual Trauma Mentions from Electronic Medical Notes Using Natural Language Processing.

PubMed

Divita, Guy; Brignone, Emily; Carter, Marjorie E; Suo, Ying; Blais, Rebecca K; Samore, Matthew H; Fargo, Jamison D; Gundlapalli, Adi V

2017-01-01

Patient history of sexual trauma is of clinical relevance to healthcare providers as survivors face adverse health-related outcomes. This paper describes a method for identifying mentions of sexual trauma within the free text of electronic medical notes. A natural language processing pipeline for information extraction was developed and scaled to handle a large corpus of electronic medical notes used for this study from US Veterans Health Administration medical facilities. The tool was used to identify sexual trauma mentions and create snippets around every asserted mention based on a domain-specific lexicon developed for this purpose. All snippets were evaluated by trained human reviewers. An overall positive predictive value (PPV) of 0.90 for identifying sexual trauma mentions from the free text and a PPV of 0.71 at the patient level are reported. The metrics are superior for records from female patients.