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Sample records for electronic record system

  1. Electronic Dental Records System Adoption.

    PubMed

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

    2015-01-01

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

  2. Recent perspectives of electronic medical record systems

    PubMed Central

    ZHANG, XIAO-YING; ZHANG, PEIYING

    2016-01-01

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

  3. Architecture for networked electronic patient record systems.

    PubMed

    Takeda, H; Matsumura, Y; Kuwata, S; Nakano, H; Sakamoto, N; Yamamoto, R

    2000-11-01

    There have been two major approaches to the development of networked electronic patient record (EPR) architecture. One uses object-oriented methodologies for constructing the model, which include the GEHR project, Synapses, HL7 RIM and so on. The second approach uses document-oriented methodologies, as applied in examples of HL7 PRA. It is practically beneficial to take the advantages of both approaches and to add solution technologies for network security such as PKI. In recognition of the similarity with electronic commerce, a certificate authority as a trusted third party will be organised for establishing networked EPR system. This paper describes a Japanese functional model that has been developed, and proposes a document-object-oriented architecture, which is-compared with other existing models. PMID:11154967

  4. 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.

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

    PubMed

    Mirza, Hebah; El-Masri, Samir

    2013-01-01

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

  6. Perfusion Electronic Record Documentation Using Epic Systems Software.

    PubMed

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

    2015-12-01

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

  7. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... recordkeeping systems for electronic records? 1236.20 Section 1236.20 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.20 What are appropriate recordkeeping systems for electronic...

  8. Perfusion Electronic Record Documentation Using Epic Systems Software

    PubMed Central

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

    2015-01-01

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

  9. [Automated anesthesia billing by electronic anesthesia record keeping system].

    PubMed

    Okamura, A; Murayama, H; Sato, N; Kemmotsu, O

    1999-08-01

    There has been loss of anesthesia fee by errors of filling out billing sheets manually. A large loss of anesthesia fee was pointed out by the audit during the past several years. In order to prevent these billing error, we have developed an automated anesthesia billing system combined with an electronic anesthesia record keeping (EARK) system. The system derives all the anesthesia cost-related parameters from the EARK database and calculates anesthesia fee according to the logic of the Japanese health care insurance system. After implementing the system, anesthesiologists and circulating nurses became free from filling out billing sheets. The accuracy of the automated billing was proved by the comparison with hand filled sheets. The survey showed that the system prevented 2.5 million yen of billing loss in a month. Such an economic impact of the system proves the rationale of an EARK as a cost containment tool.

  10. Using ISO 25040 standard for evaluating electronic health record systems.

    PubMed

    Oliveira, Marília; Novaes, Magdala; Vasconcelos, Alexandre

    2013-01-01

    Quality of electronic health record systems (EHR-S) is one of the key points in the discussion about the safe use of this kind of system. It stimulates creation of technical standards and certifications in order to establish the minimum requirements expected for these systems. [1] In other side, EHR-S suppliers need to invest in evaluation of their products to provide systems according to these requirements. This work presents a proposal of use ISO 25040 standard, which focuses on the evaluation of software products, for define a model of evaluation of EHR-S in relation to Brazilian Certification for Electronic Health Record Systems - SBIS-CFM Certification. Proposal instantiates the process described in ISO 25040 standard using the set of requirements that is scope of the Brazilian certification. As first results, this research has produced an evaluation model and a scale for classify an EHR-S about its compliance level in relation to certification. This work in progress is part for the acquisition of the degree of master in Computer Science at the Federal University of Pernambuco.

  11. Disrupting Electronic Health Records Systems: The Next Generation

    PubMed Central

    Marshall, Jeffrey David; Lai, Yuan

    2015-01-01

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

  12. A system of electronic records developed by a children's hospice.

    PubMed

    Menezes, Antoinette; Esplen, Polly; Bartlett, Paul; Turner, Bridget; Keel, Mike; Etherington, Veronica; Conisbee, Elaine; Plant, Antonia; Haslam, Val; England, Julie

    2007-05-01

    This paper describes the development, implementation and dissemination of an electronic data collection system for children's hospices in the UK. In 1999, CHASE Hospice Care for Children (CHASE) began providing support for life-limited children and their families in their own homes across south-west London, Surrey and West Sussex. CHASE community team is multidisciplinary and original members of the team had to create all of the necessary administrative systems for collecting and storing information about referrals and care provided to children and their families. The community team had the foresight to record activity statistics from day one of the service. The team worked together to identify information routinely collected that could usefully be stored on a computer database and a simple solution was created for this purpose using Microsoft Access version 2. CHASE was in a privileged position because the commitment to use information technology came from people providing care to children and their families.

  13. Confidentiality of Patron Records in Electronic Library Circulation Systems.

    ERIC Educational Resources Information Center

    Seaman, Scott

    Issues concerning the confidentiality of library-patron records in the age of electronics are explored. Confidentiality of patron records is a relatively new concept for libraries and was first introduced in the 1938 Code of Ethics of the American Library Association (ALA). Librarians have worked on a state-by-state basis to protect library…

  14. Role prediction using Electronic Medical Record system audits.

    PubMed

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

    2011-01-01

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

  15. CADe System Integrated within the Electronic Health Record

    PubMed Central

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

    2013-01-01

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

  16. CADe system integrated within the electronic health record.

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  18. Benefits and drawbacks of electronic health record systems

    PubMed Central

    Menachemi, Nir; Collum, Taleah H

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Gregory, Bob; Lonabocker, Louise

    1986-01-01

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

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

    PubMed

    Blobel, Bernd

    2004-03-31

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

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

    PubMed

    Blobel, Bernd

    2004-03-31

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

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

    ERIC Educational Resources Information Center

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

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

  3. Landsat electron beam recorder

    NASA Astrophysics Data System (ADS)

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

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

  4. Perfusion Electronic Record Documentation Using Epic Systems Software.

    PubMed

    Riley, Jeffrey B; Justison, George A

    2015-12-01

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

  5. [An electronic medical record information system of DICOM-RT module-based in radiation therapy].

    PubMed

    Xia, Deguo; Zhou, Linghong; Lei, Li

    2012-06-01

    Electronic medical records (EMR) is the clinical diagnosis, guiding intervention and digital medical service record of outpatient, hospital patients (or care object) in medical institution. And it is the complete, detailed clinical information resource which has produced and recorded in all previous medical treatments. Radiotherapy electronic medical records contain texts, images and graphics, therefore the information is more complicated. This paper proposes an EMR information system based on DICOM-RT standard, through the use of seven objects of DICOM-RT to achieve the information exchange and sharing between different systems, equipments, convenient radiotherapy treatment data management, improve the efficiency of radiation treatment.

  6. Electronic health record and electronic patient record.

    PubMed

    Dimond, Bridgit

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

  7. Electronic Systems and Records Management in the Information Age: An Introduction.

    ERIC Educational Resources Information Center

    Cox, Richard J.

    1997-01-01

    Presents a statement of requirements developed by the University of Pittsburgh School of Information Science ensuring the preservation of evidence in electronic form. Although specifically addressing electronic record-keeping systems, the requirements are also applicable to manual or hybrid systems. (PEN)

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

    NASA Astrophysics Data System (ADS)

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

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

  9. 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.

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

    NASA Astrophysics Data System (ADS)

    Davies, George

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

  11. 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…

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  13. A real time Teleconsultation System for Sharing an Oncologic Web-based Electronic Medical Record.

    PubMed

    Forti, Stefano; Galvagni, Michele; Galligioni, Enzo; Eccher, Claudio

    2005-01-01

    This poster presents an innovative real-time Teleconsultation System for synchronized navigation of the pages of a web-based Oncological Electronic Medical Record, designed to provide clinicians a cooperative work tool supporting the oncologic patient management between different hospitals. The system embeds additional tools supporting the discussion: digital whiteboard, chat and a digital audio channel.

  14. Integrating an enterprise image distribution system into an existing electronic medical record system

    NASA Astrophysics Data System (ADS)

    Witt, Robert M.; Morrow, Robert

    2003-05-01

    The enterprise distribution of radiology images should be integrated into the same application that physicians obtain other clinical information about their patients. Over the past year the Roudebush Veterans Affairs Medical Center has provided enterprise access to radiology images after integrating a commercial web-based image distribution system (Stentor, Brisbane, CA) with the Department of Veterans Affairs internally developed Computerized Patient Record System (CPRS). The application, CPRS, serves as the foundation for the VHA to implement an electronic medical record (EMR). We developed the necessary program communications between the CPRS application and the image distribution application to link the request for a report to a request for the corresponding images. When a physician selects a given radiology report in CPRS the text of the report displays in CPRS and the image application loads the corresponding image study. We found that the requests for film jackets decreased over fifty percent six months after full implementation of the enterprise image distribution system. We have found the integration of the image access and display application into an existing patient information system to be very successful.

  15. 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

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

    ERIC Educational Resources Information Center

    Zhang, Rui

    2013-01-01

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

  17. 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…

  18. 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.

  19. 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…

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

    PubMed

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

    2016-01-01

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

  1. 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

  2. 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

  3. 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

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

    PubMed

    Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

    2015-06-01

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

  5. [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.

  6. 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

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

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

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

  8. A nursing perspective to design and implementation of electronic patient record systems.

    PubMed

    Moen, Anne

    2003-01-01

    Achievements in informatics and use of new technologies are important to develop knowledge from clinical nursing practice. At the same time, progress in design and implementation of clinical information systems such as comprehensive Electronic Patient Record (EPR) systems can be complemented by attention to and examination of information processes as well as the health care constituencies' characteristics. In this article, selected issues and challenges related to EPR design and implementation are reviewed with a particular emphasis on those related to nursing practice and nursing leadership.

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

    PubMed Central

    Platt, Jodyn; Kardia, Sharon

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  11. 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…

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-01-01

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

  14. 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.

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

    PubMed

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

    2014-10-01

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

  16. 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.

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

    PubMed

    Bar-Lev, Shirly

    2015-03-01

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

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

    PubMed Central

    Bowman, Sue

    2013-01-01

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

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

    MedlinePlus

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

  20. 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

  1. 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

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

    ERIC Educational Resources Information Center

    Patterson, Giovanna; Sprehe, J. Timothy

    2002-01-01

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

  3. Disseminating context-specific access to online knowledge resources within electronic health record systems.

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    1996-01-01

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

  6. 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.

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

    PubMed

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

    2011-01-01

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

  8. The search for the elusive electronic medical record system--medical liability, the missing factor.

    PubMed

    Grams, R R; Moyer, E H

    1997-02-01

    Over the past few years, the traditional paper-based medical record system has come under close scrutiny by every participant in the healthcare industry. Some groups, especially federal agencies such as Medicare and Medicaid, HMOs, and other third party payors, have begun to demand changes in medical record documentation, and have become very assertive as to what goals and objectives will be met. In contrast, the medical liability insurance industry has remained almost invisible during this period of transition. At a recent electronic medical records (EMR) conference participants attending a software development workshop were asked if they had their systems reviewed from a medicolegal standpoint by a malpractice insurance carrier. In response to this inquiry, not one software vendor raised their hand to indicate this had been accomplished, or was even contemplated. In the author's opinion, the key missing factor in the current quest for a paperless medical office system rests in the domain of those who represent the medical liability industry. All of these gate-keepers of medical loss and risk prevention will eventually be called upon, either by choice or necessity, to validate every working EMR system that is used in medical practices in the future. This article will explore the best information published from this currently silent sector of the industry, and proposes an active involvement by the medical liability industry in the current EMR design and development processes taking place. In addition, there are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input.

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

    PubMed

    Monroe, C Douglas; Chin, Karen Y

    2013-05-01

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

  10. 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

  11. The impact of electronic health record (EHR) interoperability on immunization information system (IIS) data quality

    PubMed Central

    Woinarowicz, Mary; Howell, Molly

    2016-01-01

    Objectives: To evaluate the impact of electronic health record (EHR) interoperability on the quality of immunization data in the North Dakota Immunization Information System (NDIIS). Methods: NDIIS doses administered data was evaluated for completeness of the patient and dose-level core data elements for records that belong to interoperable and non-interoperable providers. Data was compared at three months prior to electronic health record (EHR) interoperability enhancement to data at three, six, nine and twelve months post-enhancement following the interoperability go live date. Doses administered per month and by age group, timeliness of vaccine entry and the number of duplicate clients added to the NDIIS was also compared, in addition to, immunization rates for children 19 – 35 months of age and adolescents 11 – 18 years of age. Results: Doses administered by both interoperable and non-interoperable providers remained fairly consistent from pre-enhancement through twelve months post-enhancement. Comparing immunization rates for infants and adolescents, interoperable providers had higher rates both pre- and post-enhancement than non-interoperable providers for all vaccines and vaccine series assessed. The overall percentage of doses entered into the NDIIS within one month of administration varied slightly between interoperable and non-interoperable providers; however, there were significant changes between the percentage of doses entered within one day and within one week with the percentage entered within one day increasing and within one week decreasing with interoperability. The number of duplicate client records created by interoperable providers increased from 94 duplicates pre-enhancement to 10,552 at twelve months post-enhancement, while the duplicates from non-interoperable providers only increased from 300 to 637 over the same period. Of the 40 core data elements in the NDIIS, there was some difference in completeness between the interoperable versus

  12. The impact of electronic health record (EHR) interoperability on immunization information system (IIS) data quality.

    PubMed

    Woinarowicz, Mary; Howell, Molly

    2016-01-01

    Objectives: To evaluate the impact of electronic health record (EHR) interoperability on the quality of immunization data in the North Dakota Immunization Information System (NDIIS). Methods: NDIIS doses administered data was evaluated for completeness of the patient and dose-level core data elements for records that belong to interoperable and non-interoperable providers. Data was compared at three months prior to electronic health record (EHR) interoperability enhancement to data at three, six, nine and twelve months post-enhancement following the interoperability go live date. Doses administered per month and by age group, timeliness of vaccine entry and the number of duplicate clients added to the NDIIS was also compared, in addition to, immunization rates for children 19 - 35 months of age and adolescents 11 - 18 years of age. Results: Doses administered by both interoperable and non-interoperable providers remained fairly consistent from pre-enhancement through twelve months post-enhancement. Comparing immunization rates for infants and adolescents, interoperable providers had higher rates both pre- and post-enhancement than non-interoperable providers for all vaccines and vaccine series assessed. The overall percentage of doses entered into the NDIIS within one month of administration varied slightly between interoperable and non-interoperable providers; however, there were significant changes between the percentage of doses entered within one day and within one week with the percentage entered within one day increasing and within one week decreasing with interoperability. The number of duplicate client records created by interoperable providers increased from 94 duplicates pre-enhancement to 10,552 at twelve months post-enhancement, while the duplicates from non-interoperable providers only increased from 300 to 637 over the same period. Of the 40 core data elements in the NDIIS, there was some difference in completeness between the interoperable versus non

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

    PubMed Central

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

    2015-01-01

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

  14. Quantitative ethnographic study of physician workflow and interactions with electronic health record systems

    PubMed Central

    Asan, Onur; Chiou, Erin; Montague, Enid

    2014-01-01

    This study explores the relationship between primary care physicians’ interactions with health information technology and primary care workflow. Clinical encounters were recorded with high-resolution video cameras to capture physicians’ workflow and interaction with two objects of interest, the electronic health record (EHR) system, and their patient. To analyze the data, a coding scheme was developed based on a validated list of primary care tasks to define the presence or absence of a task, the time spent on each task, and the sequence of tasks. Results revealed divergent workflows and significant differences between physicians’ EHR use surrounding common workflow tasks: gathering information, documenting information, and recommend/discuss treatment options. These differences suggest impacts of EHR use on primary care workflow, and capture types of workflows that can be used to inform future studies with larger sample sizes for more effective designs of EHR systems in primary care clinics. Future research on this topic and design strategies for effective health information technology in primary care are discussed. PMID:26279597

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

    PubMed Central

    Park, Young-Taek

    2014-01-01

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

  16. The effect of electronic medical record system sophistication on preventive healthcare for women

    PubMed Central

    Tundia, Namita L; Kelton, Christina M L; Cavanaugh, Teresa M; Guo, Jeff J; Hanseman, Dennis J; Heaton, Pamela C

    2013-01-01

    Objective To observe the effect of electronic medical record (EMR) system sophistication on preventive women's healthcare. Materials and Methods Providers in the National Ambulatory Medical Care Survey (NAMCS), 2007–8, were included if they had at least one visit by a woman at least 21 years old. Based on 16 questions from NAMCS, the level of a provider's EMR system sophistication was classified as non-existent, minimal, basic, or fully functional. A two-stage residual-inclusion method was used with ordered probit regression to model the level of EMR system sophistication, and outcome-specific Poisson regressions to predict the number of examinations or tests ordered or performed. Results Across the providers, 29.23%, 49.34%, 15.97%, and 5.46% had no, minimal, basic, and fully functional EMR systems, respectively. The breast examination rate was 20.27%, 34.96%, 37.21%, and 44.98% for providers without or with minimal, basic, and fully functional EMR systems, respectively. For breast examinations, pelvic examinations, Pap tests, chlamydia tests, cholesterol tests, mammograms, and bone mineral density (BMD) tests, an EMR system increased the number of these tests and examinations. Furthermore, the level of sophistication increased the number of breast examinations and Pap, chlamydia, cholesterol, and BMD tests. Discussion The use of advanced EMR systems in obstetrics and gynecology was limited. Given the positive results of this study, specialists in women's health should consider investing in more sophisticated systems. Conclusions The presence of an EMR system has a positive impact on preventive women's healthcare; the more functions that the system has, the greater the number of examinations and tests given or prescribed. PMID:23048007

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

    PubMed Central

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

    2011-01-01

    Objectives To examine the current status of hospital information systems (HIS), analyze the effects of Electronic Medical Records (EMR) and Clinical Decision Support Systems (CDSS) have upon hospital performance, and examine how management issues change over time according to various growth stages. Methods Data taken from the 2010 survey on the HIS status and management issues for 44 tertiary hospitals and 2009 survey on hospital performance appraisal were used. A chi-square test was used to analyze the association between the EMR and CDSS characteristics. A t-test was used to analyze the effects of EMR and CDSS on hospital performance. Results Hospital size and top management support were significantly associated with the adoption of EMR. Unlike the EMR results, however, only the standardization characteristic was significantly associated with CDSS adoption. Both EMR and CDSS were associated with the improvement of hospital performance. The EMR adoption rates and outsourcing consistently increased as the growth stage increased. The CDSS, Knowledge Management System, standardization, and user training adoption rates for Stage 3 hospitals were higher than those found for Stage 2 hospitals. Conclusions Both EMR and CDSS influenced the improvement of hospital performance. As hospitals advanced to Stage 3, i.e. have more experience with information systems, they adopted EMRs and realized the importance of each management issue. PMID:22084812

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

    PubMed Central

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

    2015-01-01

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

  19. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... storage media or formats in order to avoid loss due to media decay or technology obsolescence. (7) Execute disposition. Identify and effect the transfer of permanent records to NARA based on approved records schedules... disposition when required. (c) Backup systems. System and file backup processes and media do not provide...

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

    PubMed Central

    Fernández, Gonzalo; López-Coronado, Miguel

    2013-01-01

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

  1. Regional Epidemiologic Assessment of Prevalent Periodontitis Using an Electronic Health Record System

    PubMed Central

    Acharya, Amit; VanWormer, Jeffrey J.; Waring, Stephen C.; Miller, Aaron W.; Fuehrer, Jay T.; Nycz, Gregory R.

    2013-01-01

    An oral health surveillance platform that queries a clinical/administrative data warehouse was applied to estimate regional prevalence of periodontitis. Cross-sectional analysis of electronic health record data collected between January 1, 2006, and December 31, 2010, was undertaken in a population sample residing in Ladysmith, Wisconsin. Eligibility criteria included: 1) residence in defined zip codes, 2) age 25–64 years, and 3) ≥1 Marshfield dental clinic comprehensive examination. Prevalence was established using 2 independent methods: 1) via an algorithm that considered clinical attachment loss and probe depth and 2) via standardized Current Dental Terminology (CDT) codes related to periodontal treatment. Prevalence estimates were age-standardized to 2000 US Census estimates. Inclusion criteria were met by 2,056 persons. On the basis of the American Academy of Periodontology/Centers for Disease Control and Prevention method, the age-standardized prevalence of moderate or severe periodontitis (combined) was 407 per 1,000 males and 308 per 1,000 females (348/1,000 males and 269/1,000 females using the CDT code method). Increased prevalence and severity of periodontitis was noted with increasing age. Local prevalence of periodontitis was consistent with national estimates. The need to address potential sample selection bias in future electronic health record–based periodontitis research was identified by this approach. Methods outlined herein may be applied to refine oral health surveillance systems, inform dental epidemiologic methods, and evaluate interventional outcomes. PMID:23462966

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2011-07-01

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

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

    PubMed

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

    2015-06-01

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

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

    PubMed Central

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

    2008-01-01

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

  7. 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…

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

    ERIC Educational Resources Information Center

    Farri, Oladimeji Feyisetan

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Schwartz, Stanley F.

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

  10. Implementation of an electronic health records system within an interprofessional model of care.

    PubMed

    Elias, Beth; Barginere, Marlena; Berry, Phillip A; Selleck, Cynthia S

    2015-01-01

    Implementation of electronic health records (EHR) systems is challenging even in traditional healthcare settings, where administrative and clinical roles and responsibilities are clearly defined. However, even in these traditional settings the conflicting needs of stakeholders can trigger hierarchical decision-making processes that reflect the traditional power structures in healthcare today. These traditional processes are not structured to allow for incorporation of new patient-care models such as patient-centered care and interprofessional teams. New processes for EHR implementation and evaluation will be required as healthcare shifts to a patient-centered model that includes patients, families, multiple agencies, and interprofessional teams in short- and long-term clinical decision-making. This new model will be enabled by healthcare information technology and defined by information flow, workflow, and communication needs. We describe a model in development for the configuration and implementation of an EHR system in an interprofessional, interagency, free-clinic setting. The model uses a formative evaluation process that is rooted in usability to configure the EHR to fully support the needs of the variety of providers working as an interprofessional team. For this model to succeed, it must include informaticists as equal and essential members of the healthcare team. PMID:25955512

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed Central

    Wang, Tiankai; Biedermann, Sue

    2012-01-01

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

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

    PubMed Central

    Choi, Jong Soo; Lee, Woo Baik

    2013-01-01

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

  14. Electronic patient records for dental school clinics: more than paperless systems.

    PubMed

    Atkinson, Jane C; Zeller, Gregory G; Shah, Chhaya

    2002-05-01

    The Electronic Patient Record (EPR) or "computer-based medical record" is defined by the Patient Record Institute as "a repository for patient information with one health-care enterprise that is supported by digital computer input and integrated with other information sources." The information technology revolution coupled with everyday use of computers in clinical dentistry has created new demand for electronic patient records. Ultimately, the EPR should improve health care quality. The major short-term disadvantage is cost, including software, equipment, training, and personnel time involved in the associated business process re-engineering. An internal review committee with expertise in information technology and/or database management evaluated commercially available software in light of the unique needs of academic dental facilities. This paper discusses their deficiencies and suggests areas for improvement. The dental profession should develop a more common record with standard diagnostic codes and clinical outcome measures to make the EPR more useful for clinical research and improve the quality of care. PMID:12056768

  15. Cost-Effectiveness of an Electronic Medical Record Based Clinical Decision Support System

    PubMed Central

    Gilmer, Todd P; O'Connor, Patrick J; Sperl-Hillen, JoAnn M; Rush, William A; Johnson, Paul E; Amundson, Gerald H; Asche, Stephen E; Ekstrom, Heidi L

    2012-01-01

    Background and Objective Medical groups have invested billions of dollars in electronic medical records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system. Data Sources/Setting Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model. The simulation cohort included 1,092 patients with diabetes with A1c above goal at baseline. Study Design The United Kingdom Prospective Diabetes Study Outcomes Model, a validated simulation model of diabetes, was used to evaluate remaining life years, quality-adjusted life years (QALYs), and health care costs over patient lifetimes (40-year time horizon) from the health system perspective. Principal Findings Patients in the intervention group had significantly lowered A1c (0.26 percent, p = .014) relative to patients in the control arm. Intervention costs were $120 (SE = 45) per patient in the first year and $76 (SE = 45) per patient in the following years. In the base case analysis, EMR-based CDS increased lifetime QALYs by 0.04 (SE = 0.01) and increased lifetime costs by $112 (SE = 660), resulting in an incremental cost-effectiveness ratio of $3,017 per QALY. The cost-effectiveness of EMR-based CDS persisted in one-way, two-way, and probabilistic sensitivity analyses. Conclusions Widespread adoption of sophisticated EMR-based CDS has the potential to modestly improve the quality of care for patients with chronic conditions without substantially increasing costs to the health care system. PMID:22578085

  16. Can an electronic health record system be used for preconception health optimization?

    PubMed

    Straub, Heather; Adams, Marci; Silver, Richard K

    2014-11-01

    To explore the potential of an integrated outpatient electronic health record (EHR) for preconception health optimization. An automated case-finding EHR-derived algorithm was designed to identify women of child-bearing age having outpatient encounters in an 85-site, integrated health system. The algorithm simultaneously cross-referenced multiple discrete data fields to identify selected preconception factors (obesity, hypertension, diabetes, teratogen use including ACE inhibitors, multivitamin supplementation, anemia, renal insufficiency, untreated sexually transmitted infection, HIV positivity, and tobacco, alcohol or illegal drug use). Surveys were mailed to a random sample of patients to obtain their self-reported health profiles for these same factors. Concordance was assessed between the algorithm output, survey results, and manual data abstraction. Between 8/2010-2/2012, 107,339 female outpatient visits were identified, from which 29,691 unique women were presumed to have child-bearing potential. 19,624 (66 %) and 8,652 (29 %) had 1 or ≥2 health factors, respectively while only 1,415 (5 %) had none. Using the patient survey results as a reference point, health-factor agreement was similar comparing the algorithm (85.8 %) and the chart abstraction (87.2 %) results. Incorrect or missing data entries in the EHR encounters were largely responsible for discordances observed. Preconception screening using an automated algorithm in a system-wide EHR identified a large group of women with potentially modifiable preconception health conditions. The issue most responsible for limiting algorithm performance was incomplete point of care documentation. Accurate data capture during patient encounters should be a focus for quality improvement, so that novel applications of system-wide data mining can be reliably implemented. PMID:24627232

  17. Integration of a nationally procured electronic health record system into user work practices

    PubMed Central

    2012-01-01

    Background Evidence suggests that many small- and medium-scale Electronic Health Record (EHR) implementations encounter problems, these often stemming from users' difficulties in accommodating the new technology into their work practices. There is the possibility that these challenges may be exacerbated in the context of the larger-scale, more standardised, implementation strategies now being pursued as part of major national modernisation initiatives. We sought to understand how England's centrally procured and delivered EHR software was integrated within the work practices of users in selected secondary and specialist care settings. Methods We conducted a qualitative longitudinal case study-based investigation drawing on sociotechnical theory in three purposefully selected sites implementing early functionality of a nationally procured EHR system. The complete dataset comprised semi-structured interview data from a total of 66 different participants, 38.5 hours of non-participant observation of use of the software in context, accompanying researcher field notes, and hospital documents (including project initiation and lessons learnt reports). Transcribed data were analysed thematically using a combination of deductive and inductive approaches, and drawing on NVivo8 software to facilitate coding. Results The nationally led "top-down" implementation and the associated focus on interoperability limited the opportunity to customise software to local needs. Lack of system usability led users to employ a range of workarounds unanticipated by management to compensate for the perceived shortcomings of the system. These had a number of knock-on effects relating to the nature of collaborative work, patterns of communication, the timeliness and availability of records (including paper) and the ability for hospital management to monitor organisational performance. Conclusions This work has highlighted the importance of addressing potentially adverse unintended consequences

  18. Electronic Health Records

    MedlinePlus

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

  19. A data capture system for outcomes studies that integrates with electronic health records: development and potential uses.

    PubMed

    Yamamoto, Keiichi; Matsumoto, Shigemi; Tada, Harue; Yanagihara, Kazuhiro; Teramukai, Satoshi; Takemura, Tadamasa; Fukushima, Masanori

    2008-10-01

    In conventional clinical studies, the costs of data management for quality control tend to be high and collecting paper-based case report forms (CRFs) tends to be burdensome, because paper-based CRFs must be developed and filled out for each clinical study protocol. Use of electronic health records for this purpose could result in reductions in cost and improvements in data quality in clinical studies. The purpose of this study was to develop a data capture system for observational cancer clinical studies (i.e. outcomes studies) that would integrate with an electronic health records system, to enable evaluation of patient prognosis, prognostic factors, outcomes and drug safety. At the Outpatient Oncology Unit of Kyoto University Hospital, we developed a data capture system that includes a cancer clinical database system and a data warehouse for outcomes studies. We expect that our new system will reduce the costs of data management and analysis and improve the quality of data in clinical studies.

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

    PubMed

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

    2014-12-01

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

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

    PubMed

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

    2014-12-01

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

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

    PubMed Central

    2013-01-01

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

  3. [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.

  4. SPEEDE/ExPRESS: An Electronic System for Exchanging Student Records.

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers, Washington, DC.

    It is common for information about students to be transferred from one learning institution to another or to some other location. The ease with which student records can be transferred and understood often depends on their design, the efficiency of the delivery system, and how the information is handled by the receiver. The Standardization of…

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-06-01

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

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

    PubMed

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

    2013-06-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2005-04-01

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

  9. Problems in the Preservation of Electronic Records.

    ERIC Educational Resources Information Center

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

    2003-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Tedd, Lucy A.

    2006-01-01

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

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

    PubMed

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

    2016-09-01

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

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

    PubMed

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

    2016-09-01

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

  14. PACS and electronic health records

    NASA Astrophysics Data System (ADS)

    Cohen, Simona; Gilboa, Flora; Shani, Uri

    2002-05-01

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

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

    PubMed Central

    2014-01-01

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

  16. Automatic generation of nursing narratives from entity-attribute-value triplet for electronic nursing records system.

    PubMed

    Min, Yul Ha; Park, Hyeoun-Ae; Lee, Joo Yun; Jo, Soo Jung; Jeon, Eunjoo; Byeon, Namsoo; Choi, Seung Yong; Chung, Eunja

    2014-01-01

    The aim of this study is to develop and evaluate a natural language generation system to populate nursing narratives using detailed clinical models. Semantic, contextual, and syntactical knowledges were extracted. A natural language generation system linking these knowledges was developed. The quality of generated nursing narratives was evaluated by the three nurse experts using a five-point rating scale. With 82 detailed clinical models, in total 66,888 nursing narratives in four different types of statement were generated. The mean scores for overall quality was 4.66, for content 4.60, for grammaticality 4.40, for writing style 4.13, and for correctness 4.60. The system developed in this study generated nursing narratives with different levels of granularity. The generated nursing narratives can improve semantic interoperability of nursing data documented in nursing records.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

    Baird, Shawn; Boak, George

    2016-05-01

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

  19. Electronic medical record systems in critical access hospitals: leadership perspectives on anticipated and realized benefits.

    PubMed

    Mills, Troy R; Vavroch, Jared; Bahensky, James A; Ward, Marcia M

    2010-04-01

    The growth of electronic medical records (EMRs) is driven by the belief that EMRs will significantly improve healthcare providers' performance and reduce healthcare costs. Evidence supporting these beliefs is limited, especially for small rural hospitals. A survey that focused on health information technology (HIT) capacity was administered to all hospitals in Iowa. Structured interviews were conducted with the leadership at 15 critical access hospitals (CAHs) that had implemented EMRs in order to assess the perceived benefits of operational EMRs. The results indicate that most of the hospitals implemented EMRs to improve efficiency, timely access, and quality. Many CAH leaders also viewed EMR implementation as a necessary business strategy to remain viable and improve financial performance. While some reasons reflect external influences, such as perceived future federal mandates, other reasons suggest that the decision was driven by internal forces, including the hospital's culture and the desires of key leaders to embrace HIT. Anticipated benefits were consistent with goals; however, realized benefits were rarely obvious in terms of quantifiable results. These findings expand the limited research on the rationale for implementing EMRs in critical access hospitals.

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

    PubMed Central

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

    2015-01-01

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

  1. 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

  2. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... storage media or formats in order to avoid loss due to media decay or technology obsolescence. (7) Execute disposition. Identify and effect the transfer of permanent records to NARA based on approved records...

  3. Syndromic Surveillance Using Ambulatory Electronic Health Records

    PubMed Central

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

    2009-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2012-04-01

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

  6. Biometrics for electronic health records.

    PubMed

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

    2010-10-01

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

  7. Biometrics for electronic health records.

    PubMed

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

    2010-10-01

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

  8. Implementation of electronic medical records

    PubMed Central

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

    2011-01-01

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

  9. Automating occupational protection records systems

    SciTech Connect

    Lyon, M.; Martin, J.B.

    1991-10-01

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

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

    PubMed Central

    Barnett, Michael L; Mehrotra, Ateev

    2016-01-01

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

  11. Faculty perceptions of student documentation skills during the transition from paper-based to electronic health records systems.

    PubMed

    Mahon, Pamela Young; Nickitas, Donna M; Nokes, Kathleen M

    2010-11-01

    Nursing faculty perceptions of teaching undergraduate nursing students documentation skills using either paper-based or electronic health record systems were explored in this study. Twenty-five nursing faculty in a large urban public school of nursing were interviewed using a 13-item survey questionnaire. Responses were analyzed using the constant comparative method, and four major themes arose: teaching strategies; learning from experts; road from novice to expert; and legal, ethical, and institutional issues. Results demonstrate how faculty overcome myriad obstacles encountered while teaching clinical documentation processes. Self-efficacy theory, with its emphasis on knowledge, skills, and social context, describes how faculty are modeling behaviors necessary to succeed during this transition from paper to electronic documentation. The school of nursing is integrating the findings from this research to further informatics integration across the curricula, and ongoing research is planned to investigate issues of self-efficacy and student and clinical staff perceptions of teaching-learning clinical documentation.

  12. Validation of an electronic system for recording medical student patient encounters.

    PubMed

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

    2008-11-06

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

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

    PubMed Central

    2013-01-01

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

  14. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... electronic or digital form by means of image scanning or other forms of electronic or digital conversion. (b) Documents that are not converted to an electronic or digital form will continue to be acceptable records for... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Electronic records; other...

  15. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... electronic or digital form by means of image scanning or other forms of electronic or digital conversion. (b) Documents that are not converted to an electronic or digital form will continue to be acceptable records for... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Electronic records; other...

  16. Towards a Model Based Electronic Nursing Record

    PubMed Central

    Jansen, Niels; Bekkering, Tino; Ruber, Alexander; Gooskens, Erik; Goossen, William T.F.

    2012-01-01

    The electronic nursing record (ENR) as part of the larger electronic health record has been discussed for years. Its implementation is not that widespread as often considered. E.g. in the Netherlands, a fraction of hospitals uses it. This paper describes a nurse led project in a Dutch hospital where an electronic nursing record system has been defined, based on requirements analysis, standardization through Detail Clinical Models (DCM), and implementation. Standardization of data with DCM is a method and a format to organize clinical knowledge, concepts, and data elements such that managing and exchanging semantics of data is independent from specific technology. 28 DCM are used in the specifications of the ENR. Using the DCM standards approach and the mapping of data elements to professional terminologies enable a vendor to develop what is needed for quality care, rather then sell a fixed set product. PMID:24199083

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

    MedlinePlus

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  20. Functional Analysis of Interfaces in U.S. Military Electronic Health Record System using UFuRT Framework

    PubMed Central

    Zhang, Zhen; Walji, Muhummad F; Patel, Vimla L.; Gimbel, Ronald W.; Zhang, Jiajie

    2009-01-01

    The overall aim of this study is to evaluate the usability of U.S. military electronic health record (EHR) system AHLTA using a systematic work-centered evaluation framework UFuRT --- User, Functional, Representational, and Task Analysis. This paper with the focus of Functional Analysis (FA) of AHLTA explores operationalizable methods to study functions supported by user interfaces. A system hierarchy was created to map and uniquely identify all items on the interfaces. These items were then classified independently by 2 evaluators as Operations or Objects. Operations were further classified as either Domain or Overhead function. With acceptable inter-rater agreement, of the 1996 items in the interfaces, 61% were operations, around one fourth of which were Overhead functions. Overhead functions are hypothesized to be targets to be redesigned for improvements in usability. PMID:20351949

  1. Behavioral health electronic medical record.

    PubMed

    Lawlor, Ted; Barrows, Erik

    2008-03-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  5. Electronic system

    DOEpatents

    Robison, G H; Dickson, J F

    1960-11-15

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

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

    NASA Technical Reports Server (NTRS)

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

    1973-01-01

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

  7. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  8. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2007-11-01

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

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

    SciTech Connect

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

    1995-11-01

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

  11. 78 FR 65884 - 2014 Edition Electronic Health Record Certification Criteria: Revision to the Definition of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

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

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

    PubMed Central

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

    2013-01-01

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

  13. [Nurse's coworking to electronic medical record].

    PubMed

    Maresca, M; Gavaciuto, D; Cappelli, G

    2007-01-01

    Nephrologists need to register and look at a great number of clinical data. The use of electronic medical records may improve efficiency and reduce errors. Aim of our work is to report the experience of Villa Scassi Hospital in Genoa, where a "patient file" has been performed to improve nephrology practice management. The file contains all clinical records, laboratory and radiology data, therapy, dialysis clinics, in addition to reports of out-patients department. This system allowed a better efficiency in diagnosis and treatment of the patient. Moreover experience of nurses in employing electronic medical records is reported. A reduced number of errors was found in therapy administering, because of a only one data source for physicians and nurses. PMID:17922451

  14. ELECTRONIC SYSTEM

    DOEpatents

    Robison, G.H. et al.

    1960-11-15

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

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

    ERIC Educational Resources Information Center

    Guidry, Alicia F.

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  17. Electronic Health Records Place 1st at Indy 500

    MedlinePlus

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

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

    PubMed

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

    2015-01-01

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

  19. 77 FR 8217 - Evaluating the Usability of Electronic Health Record (EHR) Systems

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ... develop a framework for assessing the usability of health information technology (HIT) systems, EHRs in particular, and performance-oriented user interface design guidelines for EHRs. Manufacturers interested in... invited to contact NIST for information regarding participation, Letters of Understanding and...

  20. Experiences sharing of implementing Template-based Electronic Medical Record System (TEMRS) in a Hong Kong medical organization.

    PubMed

    Ting, S L; Kwok, S K; Tsang, Albert H C; Lee, W B; Yee, K F

    2011-12-01

    This paper aims to investigate the efficacy and feasibility of Template-based Electronic Medical Record System (TEMRS) and factors for its successful implementation. A TEMRS was designed and implemented in one core clinic of a Hong Kong professional multi-disciplinary medical services provider with four core clinics located in different parts of Hong Kong. Eight doctors participated in the study. Surveys and interviews were conducted to acquire the users' feedback and satisfaction level. The design, development, and the factors related to the success of the implementation of TEMRS were analyzed. In the study period, 3,032 cases were collected. The most encountered diagnosis were upper respiratory tract infection (50.59%), gastroenteritis (10.19%), dermatitis (5.87%), dyspepsia (5.28%) and rhinitis (4.82%). The system gained an overall satisfaction by the users and the most satisfied areas were rapid retrieving the necessary information of patient (75%) and fasten the diagnostic selection (75%). TEMRS is an enabling system which can reduce the user resistance in new technology with its flexibility. The consideration of cost, security, human, technical, data migration and standardization issues are essential in the implementation of the TEMRS and further research should be conducted to expand the TEMRS's implementation in health care system.

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

    PubMed

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

    2009-03-01

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

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

    PubMed Central

    Chiang, Michael F.; Starren, Justin B.

    2002-01-01

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

  3. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  5. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

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

    PubMed

    Xu Chen; Berry, Damon; Stephens, Gaye

    2015-01-01

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

  7. Clinical simulation and workflow by use of two clinical information systems, the electronic health record and digital dictation.

    PubMed

    Koldby, Sven; Schou Jensen, Iben

    2013-01-01

    Clinical information systems do not always support clinician workflows. An increasing number of unintended clinical incidents might be related to implementation of clinical information systems and to a new registration praxis of unintended clinical incidents. Evidence of performing clinical simulations before implementation of new clinical information systems provides the basis for use of this method. The intention has been to evaluate patient safety issues, functionality, workflow, and usefulness of a new solution before implementation in the hospitals. Use of a solution which integrates digital dictation and the EHR (electronic health record) were simulated in realistic and controlled clinical environments. Useful information dealing with workflow and patient safety were obtained. The clinical simulation demonstrated that the EHR locks during use of the integration of digital dictation, thus making it impossible to use the EHR or connected applications during digital dictation. The results of the simulations showed that the tested and evaluated solution does not support the clinical workflow. Conducting the simulations enabled us to improve the solution before implementation, but further development is necessary before implementation of the solution.

  8. A thematic review and a policy-analysis agenda of Electronic Health Records in the Greek National Health System.

    PubMed

    Emmanouilidou, Maria; Burke, Maria

    2013-01-01

    The increasing pressure to improve healthcare outcomes and reduce costs is driving the current agenda of governments at worldwide level and calls for a fundamental reform of the status quo of health systems. This is especially the case with the Greek NHS (National Health System), a system in continuous crisis, and with the recent ongoing financial turbulence under intensive scrutiny. Technological innovations and Electronic Health Records (EHR) in particular, are recognised as key enablers in mitigating the existing burdens of healthcare. As a result, EHR is considered a core component in technology-driven reform processes. Nonetheless, the successful implementation and adoption of EHR proves to be a challenging task due to a mixture of technological, organisational and political issues. Drawing upon experiences within the European Union (EU) healthcare setting and the Greek NHS the paper proposes a conceptual framework as a policy-analysis agenda for EHR interventions in Greece. While the context of discussion is Greece, the paper aims to also derive useful insights to healthcare policy-makers around the globe.

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

    PubMed

    Russell, Matthew

    2011-09-01

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

  10. 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.

  11. Electronic Health Record Meets Digital Library

    PubMed Central

    Humphreys, Betsy L.

    2000-01-01

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

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

    PubMed Central

    2012-01-01

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

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

    PubMed

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

    2013-08-01

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

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

    PubMed Central

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

    2014-01-01

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

  15. Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis.

    PubMed

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

    2014-12-01

    We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% confidence interval [CI] = 0.85, 1.08; I(2) = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I(2) = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes. PMID:25322302

  16. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... controls must agencies establish for records in electronic information systems? 1236.10 Section 1236.10... ELECTRONIC RECORDS MANAGEMENT Records Management and Preservation Considerations for Designing and Implementing Electronic Information Systems § 1236.10 What records management controls must agencies...

  17. [Automated anesthesia record system].

    PubMed

    Zhu, Tao; Liu, Jin

    2005-12-01

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

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

    PubMed

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

    2015-06-01

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

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

    PubMed

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

    2015-06-01

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

  20. Does Use of an Electronic Health Record with Dental Diagnostic System Terminology Promote Dental Students’ Critical Thinking?

    PubMed Central

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

    2015-01-01

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

  1. Biomedical recording system

    NASA Technical Reports Server (NTRS)

    Vick, H. A.

    1970-01-01

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

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

    PubMed Central

    Fritz, Fleur

    2015-01-01

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

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

    PubMed

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

    2013-06-01

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

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

    PubMed

    Pharow, Peter; Blobel, Bernd

    2004-01-01

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

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

    PubMed

    Graves, Stuart

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Brown, Viseeta K.

    2012-01-01

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

  7. Quality and Certification of Electronic Health Records

    PubMed Central

    Hoerbst, A.; Ammenwerth, E.

    2010-01-01

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

  8. Practical electronic information system and printed recording promote management accuracy in an early-stage small-scale non-automatic biobank.

    PubMed

    Gao, Zhimei; Gu, Yijun; Lv, Zhibao; Yu, Guangjun; Zhou, Junmei

    2015-02-01

    It is particularly necessary for biomedical researchers to obtain applicable biosamples accurately and efficiently, especially from a biobank with multiple-disease catalogs. To optimize the retrieval procedure, especially in the early stages of a non-automatic biobank, we developed a procedure that combined the electronic information system with a graphically designed printed recording system, which assisted in retrieving the samples quickly in a visualized way. In this procedure, we designed tables depending on the structure of equipment and registered the corresponding information in the tables layer by layer. Different samples from different types of diseases were first registered in the electronic system with the specific pre-allocation and barcodes. Then they were stored in the allocated position using their respective barcodes. In this way, the sample number and the location information in the electronic database were completely matched with the printed record. When the samples are needed, it is convenient to check the electronic information with the printed record. This procedure provides a convenient way to record the sample information during its lifecycle, and helps the administrator to double check information about the sample. The current solution offers an easy way for the transformation of a non-automatic biobank from the small-scale early-stage to the large-scale highly-automated level.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2010-02-01

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

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

    PubMed

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

    2013-06-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true What records...

  16. Privacy, confidentiality, and electronic medical records.

    PubMed Central

    Barrows, R C; Clayton, P D

    1996-01-01

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

  17. Electronic Health Record Application Support Service Enablers.

    PubMed

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

    2015-08-01

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

  18. Mining Electronic Health Records using Linked Data.

    PubMed

    Odgers, David J; Dumontier, Michel

    2015-01-01

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

  19. Mining Electronic Health Records using Linked Data

    PubMed Central

    Odgers, David J.; Dumontier, Michel

    2015-01-01

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

  20. Mining Electronic Health Records using Linked Data.

    PubMed

    Odgers, David J; Dumontier, Michel

    2015-01-01

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

  1. Platform links clinical data with electronic health records

    Cancer.gov

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

  2. Change management with the electronic health record.

    PubMed

    Schmucker, DeeAnn

    2009-01-01

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

  3. Electronic medical record: Time to migrate?

    PubMed Central

    Rustagi, Neeti; Singh, Ritesh

    2012-01-01

    Gone are the days when records of patients were kept in paper format. Majority of things going digital, it is inevitable that hospitals will adopt electronic medical record in near future. It is simple, reliable and cost effective in long term. PMID:23293762

  4. Electronic medical record: Time to migrate?

    PubMed

    Rustagi, Neeti; Singh, Ritesh

    2012-10-01

    Gone are the days when records of patients were kept in paper format. Majority of things going digital, it is inevitable that hospitals will adopt electronic medical record in near future. It is simple, reliable and cost effective in long term.

  5. Electronic health records: current and future use.

    PubMed

    Peters, Steve G; Khan, Munawwar A

    2014-09-01

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

  6. Patient information: confidentiality and the electronic record.

    PubMed

    Griffith, Richard

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

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

    PubMed

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

    2014-01-01

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

  8. Macro influencers of electronic health records adoption.

    PubMed

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

    2015-01-01

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

  9. Preserving electronic records: Not the easiest task

    NASA Technical Reports Server (NTRS)

    Eaton, Fynnette

    1993-01-01

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

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

    PubMed

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

    2016-06-01

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

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

    PubMed

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

    2011-01-01

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

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

    PubMed

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

    2010-07-01

    Health information technology (HIT) is engineered to promote improved quality and efficiency of care, and reduce medical errors. Healthcare organizations have made significant investments in HIT tools and the electronic medical record (EMR) is a major technological advance. The Department of Veterans Affairs was one of the first large healthcare systems to fully implement EMR. The Veterans Health Information System and Technology Architecture (VistA) began by providing an interface to review and update a patient's medical record with its computerized patient record system. However, since the implementation of the VistA system there has not been an overall substantial adoption of EMR in the ambulatory or inpatient setting. In fact, only 23.9% of physicians were using EMRs in their office-based practices in 2005. A sample from the American Medical Association revealed that EMRs were available in an office setting to 17% of physicians in late 2007 and early 2008. Of these, 17% of physicians with EMR, only 4% were considered to be fully functional EMR systems. With the exception of some large aggregate EMR databases the slow adoption of EMR has limited its use in outcomes research. This paper reviews the literature and presents the current status of and forces influencing the adoption of EMR in the office-based practice, and identifies the benefits, limitations, and overall value of EMR in the conduct of outcomes research in the US.

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

    PubMed Central

    Ajami, Sima

    2013-01-01

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

  14. 36 CFR 1225.24 - When can an agency apply previously approved schedules to electronic records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... records when the electronic records system replaces a single series of hard copy permanent records or the electronic records consist of information drawn from multiple previously scheduled permanent series. Agencies... Adelphi Road, College Park, MD 20740-6001, phone number 301-837-1738, in writing of series of records...

  15. 36 CFR 1225.24 - When can an agency apply previously approved schedules to electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... records when the electronic records system replaces a single series of hard copy permanent records or the electronic records consist of information drawn from multiple previously scheduled permanent series. Agencies... Adelphi Road, College Park, MD 20740-6001, phone number 301-837-1738, in writing of series of records...

  16. Electronic medical records in clinical teaching.

    PubMed

    Warboys, Ina; Mok, Wai Yin; Frith, Karen H

    2014-01-01

    The purpose of the project was to provide students with experiences to develop their technology competency and examine student perceptions about an academic electronic medical record (EMR) as a learning tool. Nurse educators need to integrate EMRs into their curricula to give students practice in the use of electronic documentation and retrieval of clinical information. The findings of this study indicated that students' use of EMRs at least 5 times resulted in the development of positive perceptions about their EMR experience. PMID:25073041

  17. Approaches to Recording Drug Allergies in Electronic Health Records: Qualitative Study

    PubMed Central

    Fernando, Bernard; Morrison, Zoe; Kalra, Dipak; Cresswell, Kathrin; Sheikh, Aziz

    2014-01-01

    Background Drug allergy represent an important subset of adverse drug reactions that is worthy of attention because many of these reactions are potentially preventable with use of computerised decision support systems. This is however dependent on the accurate and comprehensive recording of these reactions in the electronic health record. The objectives of this study were to understand approaches to the recording of drug allergies in electronic health record systems. Materials and Methods We undertook a case study comprising of 21 in-depth interviews with a purposefully selected group of primary and secondary care clinicians, academics, and members of the informatics and drug regulatory communities, observations in four General Practices and an expert group discussion with 15 participants from the Allergy and Respiratory Expert Resource Group of the Royal College of General Practitioners. Results There was widespread acceptance among healthcare professionals of the need for accurate recording of drug allergies and adverse drug reactions. Most drug reactions were however likely to go unreported to and/or unrecognised by healthcare professionals and, even when recognised and reported, not all reactions were accurately recorded. The process of recording these reactions was not standardised. Conclusions There is considerable variation in the way drug allergies are recorded in electronic health records. This limits the potential of computerised decision support systems to help alert clinicians to the risk of further reactions. Inaccurate recording of information may in some instances introduce new problems as patients are denied treatments that they are erroneously believed to be allergic to. PMID:24740090

  18. Comparing concepts for electronic health record architectures.

    PubMed

    Blobel, Bernd

    2002-01-01

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

  19. Teaching Electronic Health Record Communication Skills.

    PubMed

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

    2016-06-01

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

  20. Patient Perceptions of Electronic Health Records

    ERIC Educational Resources Information Center

    Lulejian, Armine

    2011-01-01

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

  1. Nurses' Perceptions of the Electronic Health Record

    ERIC Educational Resources Information Center

    Crawley, Rocquel Devonne

    2013-01-01

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

  2. Barriers to implement Electronic Health Records (EHRs)

    PubMed Central

    Ajami, Sima; Arab-Chadegani, Razieh

    2013-01-01

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

  3. Voice-Recognition System Records Inspection Data

    NASA Technical Reports Server (NTRS)

    Rochester, Larry L.

    1993-01-01

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

  4. Case study: analysis of end-user requests on electronic medical record and computerized physician order entry system of Seoul National University Hospital in Korea.

    PubMed

    Kim, Young-Ah; Shin, Soo-Yong; Jo, Eun-Mi; Park, Chan-Hee; Hwang, Min-A; Kim, Kyung Hwan; Chung, Chun Kee

    2010-01-01

    Seoul National University Hospital (SNUH) in Korea has utilized the full Electronic Medical Record (EMR) system since October 2004. Unlike other countries, most EMR systems in Korean teaching and general hospitals are in-house development systems. Therefore, we can actively respond to user requests on EMR. Here, based on 5 years of experience in EMR system operation, we analyzed 2,339 SNUH EMR user requests from 2006 to 2008 for improvement of EMR system operation and management. We classify user requests into 9 criteria based on guidelines from the SNUH medical information management team. In conclusion, the most common requests (73%) are for improvement of improving quality of care. However, requests associated with hospital enterprise, public policy, and customer service are gradually increased every year. Therefore, we suggest that suitable EMR management criteria are necessary for reliable EMR operation and management.

  5. Electronic Health Records and Quality of Care

    PubMed Central

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

    2016-01-01

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

  6. Spaceborne electronic imaging systems

    NASA Technical Reports Server (NTRS)

    1971-01-01

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

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

    PubMed

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

    2006-01-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2013-01-01

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

  10. Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems.

    PubMed

    de Lusignan, Simon; Pearce, Christopher; Munro, Neil

    2013-01-01

    Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.

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

    PubMed

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

    2014-01-01

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

  12. Using Machine Learning and Natural Language Processing Algorithms to Automate the Evaluation of Clinical Decision Support in Electronic Medical Record Systems

    PubMed Central

    Szlosek, Donald A; Ferrett, Jonathan

    2016-01-01

    Introduction: As the number of clinical decision support systems (CDSSs) incorporated into electronic medical records (EMRs) increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. The authors use machine learning and Natural Language Processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an EMR system, and they compare it against manual evaluation. Methods: Modeled after the EMR system EPIC at Maine Medical Center, we developed a dummy data set containing physician notes in free text for 3,621 artificial patients records undergoing a head computed tomography (CT) scan for mild traumatic brain injury after the incorporation of an electronic best practice approach. We validated the accuracy of the Best Practice Advisories (BPA) using three machine learning algorithms—C-Support Vector Classification (SVC), Decision Tree Classifier (DecisionTreeClassifier), k-nearest neighbors classifier (KNeighborsClassifier)—by comparing their accuracy for adjudicating the occurrence of a mild traumatic brain injury against manual review. We then used the best of the three algorithms to evaluate the effectiveness of the BPA, and we compared the algorithm’s evaluation of the BPA to that of manual review. Results: The electronic best practice approach was found to have a sensitivity of 98.8 percent (96.83–100.0), specificity of 10.3 percent, PPV = 7.3 percent, and NPV = 99.2 percent when reviewed manually by abstractors. Though all the machine learning algorithms were observed to have a high level of prediction, the SVC displayed the highest with a sensitivity 93.33 percent (92.49–98.84), specificity of 97.62 percent (96.53–98.38), PPV = 50.00, NPV = 99.83. The SVC algorithm was observed to have a sensitivity of 97.9 percent (94.7–99.86), specificity 10.30 percent, PPV 7.25 percent, and NPV 99.2 percent for

  13. Using Machine Learning and Natural Language Processing Algorithms to Automate the Evaluation of Clinical Decision Support in Electronic Medical Record Systems

    PubMed Central

    Szlosek, Donald A; Ferrett, Jonathan

    2016-01-01

    Introduction: As the number of clinical decision support systems (CDSSs) incorporated into electronic medical records (EMRs) increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. The authors use machine learning and Natural Language Processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an EMR system, and they compare it against manual evaluation. Methods: Modeled after the EMR system EPIC at Maine Medical Center, we developed a dummy data set containing physician notes in free text for 3,621 artificial patients records undergoing a head computed tomography (CT) scan for mild traumatic brain injury after the incorporation of an electronic best practice approach. We validated the accuracy of the Best Practice Advisories (BPA) using three machine learning algorithms—C-Support Vector Classification (SVC), Decision Tree Classifier (DecisionTreeClassifier), k-nearest neighbors classifier (KNeighborsClassifier)—by comparing their accuracy for adjudicating the occurrence of a mild traumatic brain injury against manual review. We then used the best of the three algorithms to evaluate the effectiveness of the BPA, and we compared the algorithm’s evaluation of the BPA to that of manual review. Results: The electronic best practice approach was found to have a sensitivity of 98.8 percent (96.83–100.0), specificity of 10.3 percent, PPV = 7.3 percent, and NPV = 99.2 percent when reviewed manually by abstractors. Though all the machine learning algorithms were observed to have a high level of prediction, the SVC displayed the highest with a sensitivity 93.33 percent (92.49–98.84), specificity of 97.62 percent (96.53–98.38), PPV = 50.00, NPV = 99.83. The SVC algorithm was observed to have a sensitivity of 97.9 percent (94.7–99.86), specificity 10.30 percent, PPV 7.25 percent, and NPV 99.2 percent for

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

    PubMed Central

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

    2013-01-01

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

  15. Legal Considerations for Electronic Health Records.

    PubMed

    Mostofi, Sherry; Hoffman, Andrew L

    2015-05-01

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

  16. National electronic health record interoperability chronology.

    PubMed

    Hufnagel, Stephen P

    2009-05-01

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

  17. Legal Considerations for Electronic Health Records.

    PubMed

    Mostofi, Sherry; Hoffman, Andrew L

    2015-05-01

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

  18. Downhole recording system for MWD

    SciTech Connect

    Franz, D.G.

    1981-01-01

    Downhole recording systems are an important category of measurement-while-drilling (MWD) systems that has been obscured by the recent concentration of development work on mud-pulse communications systems. The recording system can serve a segment of the MWD market that cannot be economically served, at present, by systems having real-time data communications. This paper describes the development of a downhole recording system. 2 refs.

  19. 76 FR 13991 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-15

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

  20. Electron beam focusing system

    SciTech Connect

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

    1997-09-01

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

  1. Effect of an Electronic Health Record on the Culture of an Outpatient Medical Oncology Practice in a Four-Hospital Integrated Health Care System: 5-Year Experience

    PubMed Central

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

    2011-01-01

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

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

    PubMed

    Kropf, Stefan; Chalopin, Claire; Denecke, Kerstin

    2015-01-01

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

  3. Big data and the electronic health record.

    PubMed

    Peters, Steve G; Buntrock, James D

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Akpabio, Akpabio Enebong Ema

    2013-01-01

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

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

    EPA Science Inventory

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

  6. 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

  7. 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.

  8. 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.

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

    PubMed

    Rind, D M; Safran, C

    1993-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

  11. We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England

    PubMed Central

    2012-01-01

    Background In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders’ experiences and the local consequences of the implementation of an EHR system into a mental health hospital. Methods Longitudinal, real-time, case study-based evaluation of the implementation and adoption of an EHR software (RiO) into an English mental health hospital known here as Beta. We conducted 48 in-depth interviews with a wide range of internal and external stakeholders, undertook 26 hours of on-site observations, and obtained 65 sets of relevant documents from various types relating to Beta. Analysis was both inductive and deductive, the latter being informed by the ‘sociotechnical changing’ theoretical framework. Results Many interviewees perceived the implementation of the EHR system as challenging and cumbersome. During the early stages of the implementation, some clinicians felt that using the software was time-consuming leading to the conclusion that the EHR was not fit for purpose. Most interviewees considered the chain of deployment of the EHR–which was imposed by NPfIT–as bureaucratic and obstructive, which restricted customization and as a result limited adoption and use. The low IT literacy among users at Beta was a further barrier to the implementation of the EHR. This along with inadequate training in using the EHR software led to resistance to the significant cultural and work environment changes initiated by EHR. Despite the many challenges, Beta achieved some early positive results. These included: the ability to

  12. Task centered visualization of Electronic Medical Record flow sheet.

    PubMed

    Xie, Zhong; Gregg, Peggy; Zhang, Jiajie

    2003-01-01

    Usability problem of Electronic Medical Record (EMR) systems is a major hurdle for their acceptance. In this study we used the methodology of Human-Centered Distributed Information Design (HCDID) to compare and evaluate Flow Sheet module of two commercial EMR systems. After which we tried to develop usable interface of a flow sheet using visualization, focusing on task-representation mapping during design and development.

  13. [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. PMID:25475524

  14. 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.

  15. Ethical questions must be considered for electronic health records.

    PubMed

    Spriggs, Merle; Arnold, Michael V; Pearce, Christopher M; Fry, Craig

    2012-09-01

    National electronic health record initiatives are in progress in many countries around the world but the debate about the ethical issues and how they are to be addressed remains overshadowed by other issues. The discourse to which all others are answerable is a technical discourse, even where matters of privacy and consent are concerned. Yet a focus on technical issues and a failure to think about ethics are cited as factors in the failure of the UK health record system. In this paper, while the prime concern is the Australian Personally Controlled Electronic Health Record (PCEHR), the discussion is relevant to and informed by the international context. The authors draw attention to ethical and conceptual issues that have implications for the success or failure of electronic health records systems. Important ethical issues to consider as Australia moves towards a PCEHR system include: issues of equity that arise in the context of personal control, who benefits and who should pay, what are the legitimate uses of PCEHRs, and how we should implement privacy. The authors identify specific questions that need addressing.

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

    PubMed

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

    2015-11-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Recent developments in electronic medical records.

    PubMed

    Worth, E R

    1998-05-01

    Human factors engineering principles will guide the development of future EMR systems. Physicians will use wireless palmtop computers to record patient data so that the computer does not come between the physician and patient in routine encounters. With few exceptions, the pieces for this type of system are available today, but not in one package. I believe EMR developers have recognized the ubiquity and power of the Internet. Because of advances in computers, software, and telecommunications reliability, solutions using thin-client technology will lower the cost of EMRs to physicians. PMID:9604665

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

    PubMed

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

    2012-01-01

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

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

    PubMed

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

    1995-01-01

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

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

    PubMed

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

    1995-01-01

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

  2. Electronic health records for cardiovascular medicine.

    PubMed

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

    2014-01-01

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

  3. Transforming Education for Electronic Health Record Implementation.

    PubMed

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

    2015-08-01

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

  4. 76 FR 66916 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-28

    ... Files (October 14, 2010, 75 FR 63160). Changes: * * * * * System location: Delete entry and replace with... have been created.'' * * * * * DWHS E05 System name: Mandatory Declassification Review Files. System... the system: Storage: Paper records in file folders and electronic storage media....

  5. Breaches of health information: are electronic records different from paper records?

    PubMed

    Sade, Robert M

    2010-01-01

    Breaches of electronic medical records constitute a type of healthcare error, but should be considered separately from other types of errors because the national focus on the security of electronic data justifies special treatment of medical information breaches. Guidelines for protecting electronic medical records should be applied equally to paper medical records.

  6. 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…

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

    PubMed

    Pruski, Cédric; Wisniewski, François

    2012-01-01

    The recent development of eHealth platforms across the world, whose main objective is to centralize patient's healthcare information to ensure the best continuity of care, requires the development of advanced tools and techniques for supporting health professionals in retrieving relevant information in this vast quantity of data. However, for preserving patient's privacy, some countries decided to de-identify and encrypt data contained in the shared Electronic Health Records, which reinforces the complexity of proposing efficient medical information retrieval approach. In this paper, we describe an original approach exploiting standards metadata as well as knowledge organizing systems to overcome the barriers of data encryption for improving the results of medical information retrieval in centralized and encrypted Electronic Health Records. This is done through the exploitation of semantic properties provided by knowledge organizing systems, which enable query expansion. Furthermore, we provide an overview of the approach together with illustrating examples and a discussion on the advantages and limitations of the provided framework.

  8. Measuring the modified early warning score and the Rothman Index: Advantages of utilizing the electronic medical record in an early warning system

    PubMed Central

    Finlay, G Duncan; Rothman, Michael J; Smith, Robert A

    2014-01-01

    Early detection of an impending cardiac or pulmonary arrest is an important focus for hospitals trying to improve quality of care. Unfortunately, all current early warning systems suffer from high false-alarm rates. Most systems are based on the Modified Early Warning Score (MEWS); 4 of its 5 inputs are vital signs. The purpose of this study was to compare the accuracy of MEWS against the Rothman Index (RI), a patient acuity score based upon summation of excess risk functions that utilize additional data from the electronic medical record (EMR). MEWS and RI scores were computed retrospectively for 32,472 patient visits. Nursing assessments, a category of EMR inputs only used by the RI, showed sharp differences 24 hours before death. Receiver operating characteristic curves for 24-hour mortality demonstrated superior RI performance with c-statistics, 0.82 and 0.93, respectively. At the point where MEWS triggers an alarm, we identified the RI point corresponding to equal sensitivity and found the positive likelihood ratio (LR+) for MEWS was 7.8, and for the RI was 16.9 with false alarms reduced by 53%. At the RI point corresponding to equal LR+, the sensitivity for MEWS was 49% and 77% for RI, capturing 54% more of those patients who will die within 24 hours. Journal of Hospital Medicine 2014;9:116–119. 2013 The Authors. Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine PMID:24357519

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

    PubMed

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

    2012-01-01

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

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

    PubMed Central

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

    2011-01-01

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

  11. Electronic Education System Model.

    ERIC Educational Resources Information Center

    Cloete, Elsabe

    2001-01-01

    Discusses electronic learning efforts and problems in implementing computers in schools. Defines and describes an electronic educational system model that was developed to assist the designers of different electronic learning settings to plan and successfully implement a specific learning situation, with the focus on the individual requirements of…

  12. Electronic Medical Business Operations System

    SciTech Connect

    Cannon, D. T.; Metcalf, J. R.; North, M. P.; Richardson, T. L.; Underwood, S. A.; Shelton, P. M.; Ray, W. B.; Morrell, M. L.; Caldwell, III, D. C.

    2012-04-16

    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 Nuclear 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

  13. Electronic Medical Business Operations System

    2012-04-16

    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 Securitymore » Complex is currently investing funds to develop a comprehensive EMR to incorporate the requirements of an occupational health facility which are common across the Nuclear 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

  14. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CFR Part 212 must have access to hours of service records created and maintained electronically that... 49 Transportation 4 2011-10-01 2011-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic...

  15. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CFR Part 212 must have access to hours of service records created and maintained electronically that... 49 Transportation 4 2010-10-01 2010-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic...

  16. Project Records Information System (PRIS)

    SciTech Connect

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

    1990-11-01

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

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

    PubMed

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

    2013-03-01

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

  18. 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.

  19. Healthcare risk management challenges created by federal regulation of electronic medical records and care management.

    PubMed

    Hofert, James; Bossen, Roy; Schramm, Linnea; Dowell, Michael

    2013-01-01

    Health information technology (HIT) continues to evolve at an ever accelerating pace. Recent federal legislation has encouraged the widespread adoption of electronic record systems in the healthcare environment.(1) The federal government recognizes that advanced electronic health record (EHR) systems with clinical decision support (CDS) functionalities have the potential to offer numerous benefits to the quality of patient care.(2.)

  20. 75 FR 63160 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-14

    ... E05 System name: Mandatory Declassification Review Files (March 28, 2007; 72 FR 14533). Changes... Declassification Review Files. System location: Chief, Records and Declassification Division, Executive Services... the system: Storage: Paper file folders and electronic storage media. Retrievability: Retrieved...

  1. Predictability Bounds of Electronic Health Records

    PubMed Central

    Dahlem, Dominik; Maniloff, Diego; Ratti, Carlo

    2015-01-01

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

  2. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems

    PubMed Central

    Sittig, Dean F; Ash, Joan S; Feblowitz, Joshua; Meltzer, Seth; McMullen, Carmit; Guappone, Ken; Carpenter, Jim; Richardson, Joshua; Simonaitis, Linas; Evans, R Scott; Nichol, W Paul; Middleton, Blackford

    2011-01-01

    Background Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. Objective To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. Study design and methods We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Results Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. Conclusion We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content. PMID:21415065

  3. 75 FR 61453 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-05

    ... Defense. A0036-2 USAAA System Name: Army Audit Agency System for Information Storage System Location: U.S..., Retrieving, Accessing, Retaining, and Disposing of Records in the System: Storage: Electronic storage media... Department of the Army Privacy Act of 1974; System of Records AGENCY: Department of the Army; DoD....

  4. 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.

  5. Integrated electronics for peripheral nerve recording and signal processing.

    PubMed

    Limnuson, Kanokwan; Tyler, Dustin J; Mohseni, Pedram

    2009-01-01

    This paper describes the integrated circuit implementation of an electronic system for peripheral nerve recording and signal processing. Specifically, the system aims to record and condition neural activity from the phrenic nerve as a good indicator for breathing, and generate a stimulus trigger signal for a laryngeal pacemaker device to reanimate a paralyzed muscle with electrical stimulation paced with respiration. The 2.2 x 2.2-mm(2) integrated circuit is fabricated using the AMI 1.5 microm 2P/2M n-well CMOS process, and consumes 1 mW from +/-1.5 V. System architecture, circuit design, simulation results, and measurement data in benchtop experiments are presented.

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

    PubMed

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

    2012-09-01

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

  7. Design and anticipated outcomes of the eMERGE-PGx project: a multicenter pilot for preemptive pharmacogenomics in electronic health record systems.

    PubMed

    Rasmussen-Torvik, L J; Stallings, S C; Gordon, A S; Almoguera, B; Basford, M A; Bielinski, S J; Brautbar, A; Brilliant, M H; Carrell, D S; Connolly, J J; Crosslin, D R; Doheny, K F; Gallego, C J; Gottesman, O; Kim, D S; Leppig, K A; Li, R; Lin, S; Manzi, S; Mejia, A R; Pacheco, J A; Pan, V; Pathak, J; Perry, C L; Peterson, J F; Prows, C A; Ralston, J; Rasmussen, L V; Ritchie, M D; Sadhasivam, S; Scott, S A; Smith, M; Vega, A; Vinks, A A; Volpi, S; Wolf, W A; Bottinger, E; Chisholm, R L; Chute, C G; Haines, J L; Harley, J B; Keating, B; Holm, I A; Kullo, I J; Jarvik, G P; Larson, E B; Manolio, T; McCarty, C A; Nickerson, D A; Scherer, S E; Williams, M S; Roden, D M; Denny, J C

    2014-10-01

    We describe here the design and initial implementation of the eMERGE-PGx project. eMERGE-PGx, a partnership of the Electronic Medical Records and Genomics Network and the Pharmacogenomics Research Network, has three objectives: (i) to deploy PGRNseq, a next-generation sequencing platform assessing sequence variation in 84 proposed pharmacogenes, in nearly 9,000 patients likely to be prescribed drugs of interest in a 1- to 3-year time frame across several clinical sites; (ii) to integrate well-established clinically validated pharmacogenetic genotypes into the electronic health record with associated clinical decision support and to assess process and clinical outcomes of implementation; and (iii) to develop a repository of pharmacogenetic variants of unknown significance linked to a repository of electronic health record-based clinical phenotype data for ongoing pharmacogenomics discovery. We describe site-specific project implementation and anticipated products, including genetic variant and phenotype data repositories, novel variant association studies, clinical decision support modules, clinical and process outcomes, approaches to managing incidental findings, and patient and clinician education methods.

  8. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49 CFR Part 212 must have access to hours of service...

  9. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49 CFR Part 212 must have access to hours of service...

  10. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49 CFR Part 212 must have access to hours of service...

  11. Updated Electronic Testbed System

    NASA Technical Reports Server (NTRS)

    Brewer, Kevin L.

    2001-01-01

    As we continue to advance in exploring space frontiers, technology must also advance. The need for faster data recovery and data processing is crucial. In this, the less equipment used, and lighter that equipment is, the better. Because integrated circuits become more sensitive in high altitude, experimental verification and quantification is required. The Center for Applied Radiation Research (CARR) at Prairie View A&M University was awarded a grant by NASA to participate in the NASA ER-2 Flight Program, the APEX balloon flight program, and the Student Launch Program. These programs are to test anomalous errors in integrated circuits due to single event effects (SEE). CARR had already begun experiments characterizing the SEE behavior of high speed and high density SRAM's. The research center built a error testing system using a PC-104 computer unit, an Iomega Zip drive for storage, a test board with the components under test, and a latchup detection and reset unit. A test program was written to continuously monitor a stored data pattern in the SRAM chip and record errors. The devices under test were eight 4Mbit memory chips totaling 4Mbytes of memory. CARR was successful at obtaining data using the Electronic TestBed System (EBS) in various NASA ER-2 test flights. These series of high altitude flights of up to 70,000 feet, were effective at yielding the conditions which single event effects usually occur. However, the data received from the series of flights indicated one error per twenty-four hours. Because flight test time is very expensive, the initial design proved not to be cost effective. The need for orders of magnitude with more memory became essential. Therefore, a project which could test more memory within a given time was created. The goal of this project was not only to test more memory within a given time, but also to have a system with a faster processing speed, and which used less peripherals. This paper will describe procedures used to build an

  12. Electronic Document Supply Systems.

    ERIC Educational Resources Information Center

    Cawkell, A. E.

    1991-01-01

    Describes electronic document delivery systems used by libraries and document image processing systems used for business purposes. Topics discussed include technical specifications; analogue read-only laser videodiscs; compact discs and CD-ROM; WORM; facsimile; ADONIS (Article Delivery over Network Information System); DOCDEL; and systems at the…

  13. GSFC specification electronic data processing magnetic recording tape

    NASA Technical Reports Server (NTRS)

    Tinari, D. F.; Perry, J. L.

    1980-01-01

    The design requirements are given for magnetic oxide coated, electronic data processing tape, wound on reels. Magnetic recording tape types covered by this specification are intended for use on digital tape transports using the Non-Return-to-Zero-change-on-ones (NRZI) recording method for recording densities up to and including 800 characters per inch (cpi) and the Phase-Encoding (PE) recording method for a recording density of 1600 cpi.

  14. The effect of electronic patient records on hepatitis B vaccination completion rates at a genitourinary medicine clinic.

    PubMed

    Kuria, Patrick; Brook, Gary; McSorley, John

    2016-05-01

    The study was conducted to assess whether the introduction of an electronic patient records-based system affected hepatitis B vaccination completion rates and post-vaccination return rates, when compared to a paper-based system. Data were gathered for three groups of patients: those commencing vaccination (a) when paper records were in use (paper records group), (b) after electronic patient records were introduced (basic electronic patient records group) and (c) after electronic patient records were enhanced with recall (enhanced electronic patient records group). Compared to the paper records group, the third dose completion rates for patients managed using electronic patient records did not differ significantly: 74/119 (62.2%) paper vs. 58/98 (59.2%) basic electronic patient records, p = 0.652 and 89/130 (68.5%) enhanced electronic patient records, p = 0.298. On sub-group analysis, completion rates in patients of black ethnicity in the enhanced electronic patient records group were significantly higher than those in the paper records group: 16/19 (84.2%) enhanced electronic patient records vs. 11/23 (47.8%) paper, p = 0.014. Patients in the enhanced electronic patient records group were more likely than those in the paper records group to attend for measurement of hepatitis B surface antibody levels: 61/130 (46.9%) vs. 39/119 (32.8%), p = 0.023.

  15. Standards for the Content of the Electronic Health Record

    PubMed Central

    Watzlaf, Valerie J.M; Zeng, Xiaoming; Jarymowycz, Christine; Firouzan, Patti Anania

    2004-01-01

    A descriptive, cross-sectional study was performed to measure the awareness, use, and validity of the minimum content recommended in the American Society for Testing and Materials (ASTM) standards for content and structure of electronic health records. A Web-based survey was developed and used as the primary tool to collect this data. Data was collected from a random sample of healthcare facilities from across the country, vendors, and volunteers. Thirteen percent of respondents had an electronic health record (EHR) system fully in place while 10 percent did not have or did not plan to have an EHR system. The majority of respondents (62 percent) used a vendor system for EHR development. The majority of respondents were not aware or slightly aware of the ASTM E1384 standards. Respondents believed that the minimum data elements outlined in the ASTM standards should be included in all EHR systems. Data items such as educational level, patient instructions related to disposition, problem numbers, treatment plan ID, provider agency ID code, and medication date of last refill should not always be included in EHR systems. PMID:18066381

  16. Recording media on materials with electron capture

    NASA Astrophysics Data System (ADS)

    Petrov, Viacheslav V.; Zimenko, Vladislav I.; Kravets, Vasyliy G.

    1993-12-01

    Theoretic research and experimental investigations are showing the possibility of repeated information recording and read-out on new recording media with optically stimulated luminescence (OSL) effect. OSL concentration and spectral dependencies in Ca(Sr)S:Eu2+(Ce3+)-Sm3+ were determined. OSL in CaS films doped only by Sm3+ ions was detected.

  17. The evolution of the electronic health record.

    PubMed

    Doyle-Lindrud, Susan

    2015-04-01

    Medical record documentation of patient data has evolved during the past several years. Early patient medical records included brief, written case history reports maintained for teaching purposes. One such document obtained is a text from Egypt of 48 case reports that includes injuries, fractures, wounds, dislocations, and tumors that date back to 1600 BC. This document was written on papyrus text and acquired by Edwin Smith, an Egyptologist, in 1862 (Atta, 1999; Gillum, 2013). Case reports served as the patient record for many years, used only intermittently by physicians. By the 1880s, concerns regarding medical records as legal documents for insurance and malpractice cases encouraged administrators of hospitals to supervise record content (Gillum, 2013). By 1898, the patient record came to the bedside, moving from retrospective documentation to cases reported in actual time. Medical records resembled more of the present-day record with family history, patient habits, previous illnesses, present illness, physical examination, admission urine, blood analysis, progress notes, discharge diagnosis, and instructions (Gillum, 2013). 
. PMID:25840379

  18. Teaching Electronic Records Management in the Archival Curriculum

    ERIC Educational Resources Information Center

    Zhang, Jane

    2016-01-01

    Electronic records management has been incorporated into the archival curriculum in North America since the 1990s. This study reported in this paper provides a systematic analysis of the content of electronic records management (ERM) courses currently taught in archival education programs. Through the analysis of course combinations and their…

  19. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  20. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  1. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  2. Technology Acceptance of Electronic Medical Records by Nurses

    ERIC Educational Resources Information Center

    Stocker, Gary

    2010-01-01

    The purpose of this study was to evaluate the Technology Acceptance Model's (TAM) relevance of the intention of nurses to use electronic medical records in acute health care settings. The basic technology acceptance research of Davis (1989) was applied to the specific technology tool of electronic medical records (EMR) in a specific setting…

  3. Electronic Imaging in Admissions, Records & Financial Aid Offices.

    ERIC Educational Resources Information Center

    Perkins, Helen L.

    Over the years, efforts have been made to work more efficiently with the ever increasing number of records and paper documents that cross workers' desks. Filing records on optical disk through electronic imaging is an alternative that many feel is the answer to successful document management. The pioneering efforts in electronic imaging in…

  4. 78 FR 14282 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-05

    ... Individuals,'' dated February 8, 1996 (February 20, 1996, 61 FR 6427). Dated: February 28, 2013. Aaron Siegel... Access Management System (TEAMS) (April 29, 2004, 69 FR 23497). Changes: * * * * * Categories of records... electronic storage media.'' * * * * * Safeguards: Delete entry and replace with ``Electronic records...

  5. Open source cardiology electronic health record development for DIGICARDIAC implementation

    NASA Astrophysics Data System (ADS)

    Dugarte, Nelson; Medina, Rubén.; Huiracocha, Lourdes; Rojas, Rubén.

    2015-12-01

    This article presents the development of a Cardiology Electronic Health Record (CEHR) system. Software consists of a structured algorithm designed under Health Level-7 (HL7) international standards. Novelty of the system is the integration of high resolution ECG (HRECG) signal acquisition and processing tools, patient information management tools and telecardiology tools. Acquisition tools are for management and control of the DIGICARDIAC electrocardiograph functions. Processing tools allow management of HRECG signal analysis searching for indicative patterns of cardiovascular pathologies. Telecardiology tools incorporation allows system communication with other health care centers decreasing access time to the patient information. CEHR system was completely developed using open source software. Preliminary results of process validation showed the system efficiency.

  6. 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

  7. 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

  8. Electronic health records: new opportunities for clinical research.

    PubMed

    Coorevits, P; Sundgren, M; Klein, G O; Bahr, A; Claerhout, B; Daniel, C; Dugas, M; Dupont, D; Schmidt, A; Singleton, P; De Moor, G; Kalra, D

    2013-12-01

    Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources. PMID:23952476

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

    PubMed

    Smith, Timothy Ryan

    2016-10-01

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

  10. Securing electronic health records with broadcast encryption schemes.

    PubMed

    Susilo, Willy; Win, Khin Than

    2006-01-01

    Information security is a concern in integrated electronic health record systems (EHRs). This paper discusses the development of a mathematical model to secure the access of EHRs. In this paper, we incorporate the notion of a broadcast encryption scheme for securing EHRs. We present a novel solution to allow a secure access to the EHRs whilst minimising the number of the encrypted ciphertexts. In a nutshell, our proposed solution enjoys shorter ciphertexts compared to having multiple ciphertexts encrypted for several different participants. Our proposed solution is applicable in practice to solve an existing open problem in the effort of securing EHRs.

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

    PubMed

    Smith, Timothy Ryan

    2016-10-01

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

  12. Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

    PubMed Central

    Leykum, Luci K; McDaniel, Reuben R

    2011-01-01

    Objective Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Design Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. Measurements An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group—including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Results Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and

  13. Paleomagnetic recording fidelity of nonideal magnetic systems

    PubMed Central

    Muxworthy, Adrian R; Krása, David; Williams, Wyn; Almeida, Trevor P

    2014-01-01

    A suite of near-identical magnetite nanodot samples produced by electron-beam lithography have been used to test the thermomagnetic recording fidelity of particles in the 74–333 nm size range; the grain size range most commonly found in rocks. In addition to controlled grain size, the samples had identical particle spacings, meaning that intergrain magnetostatic interactions could be controlled. Their magnetic hysteresis parameters were indicative of particles thought not to be ideal magnetic recorders; however, the samples were found to be excellent thermomagnetic recorders of the magnetic field direction. They were also found to be relatively good recorders of the field intensity in a standard paleointensity experiment. The samples' intensities were all within ∼15% of the expected answer and the mean of the samples within 3% of the actual field. These nonideal magnetic systems have been shown to be reliable records of the geomagnetic field in terms of both direction and intensity even though their magnetic hysteresis characteristics indicate less than ideal magnetic grains. Key Points Nonideal magnetic systems accurately record field direction Weak-field remanences more stable than strong-field remanences PMID:26300699

  14. Query log analysis of an electronic health record search engine.

    PubMed

    Yang, Lei; Mei, Qiaozhu; Zheng, Kai; Hanauer, David A

    2011-01-01

    We analyzed a longitudinal collection of query logs of a full-text search engine designed to facilitate information retrieval in electronic health records (EHR). The collection, 202,905 queries and 35,928 user sessions recorded over a course of 4 years, represents the information-seeking behavior of 533 medical professionals, including frontline practitioners, coding personnel, patient safety officers, and biomedical researchers for patient data stored in EHR systems. In this paper, we present descriptive statistics of the queries, a categorization of information needs manifested through the queries, as well as temporal patterns of the users' information-seeking behavior. The results suggest that information needs in medical domain are substantially more sophisticated than those that general-purpose web search engines need to accommodate. Therefore, we envision there exists a significant challenge, along with significant opportunities, to provide intelligent query recommendations to facilitate information retrieval in EHR.

  15. Modular electronics packaging system

    NASA Technical Reports Server (NTRS)

    Hunter, Don J. (Inventor)

    2001-01-01

    A modular electronics packaging system includes multiple packaging slices that are mounted horizontally to a base structure. The slices interlock to provide added structural support. Each packaging slice includes a rigid and thermally conductive housing having four side walls that together form a cavity to house an electronic circuit. The chamber is enclosed on one end by an end wall, or web, that isolates the electronic circuit from a circuit in an adjacent packaging slice. The web also provides a thermal path between the electronic circuit and the base structure. Each slice also includes a mounting bracket that connects the packaging slice to the base structure. Four guide pins protrude from the slice into four corresponding receptacles in an adjacent slice. A locking element, such as a set screw, protrudes into each receptacle and interlocks with the corresponding guide pin. A conduit is formed in the slice to allow electrical connection to the electronic circuit.

  16. Cockpit Ocular Recording System (CORS)

    NASA Technical Reports Server (NTRS)

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

    1990-01-01

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

  17. Application of routine electronic health record databases for pharmacogenetic research.

    PubMed

    Yasmina, A; Deneer, V H M; Maitland-van der Zee, A H; van Staa, T P; de Boer, A; Klungel, O H

    2014-06-01

    Inter-individual variability in drug responses is a common problem in pharmacotherapy. Several factors (non-genetic and genetic) influence drug responses in patients. When aiming to obtain an optimal benefit-risk ratio of medicines and with the emergence of genotyping technology, pharmacogenetic studies are important for providing recommendations on drug treatments. Advances in electronic healthcare information systems can contribute to increasing the quality and efficiency of such studies. This review describes the definition of pharmacogenetics, gene selection and study design for pharmacogenetic research. It also summarizes the potential of linking pharmacoepidemiology and pharmacogenetics (along with its strengths and limitations) and provides examples of pharmacogenetic studies utilizing electronic health record databases. PMID:24581153

  18. Detecting Inappropriate Access to Electronic Health Records Using Collaborative Filtering

    PubMed Central

    Menon, Aditya Krishna; Jiang, Xiaoqian; Kim, Jihoon; Vaidya, Jaideep; Ohno-Machado, Lucila

    2013-01-01

    Many healthcare facilities enforce security on their electronic health records (EHRs) through a corrective mechanism: some staff nominally have almost unrestricted access to the records, but there is a strict ex post facto audit process for inappropriate accesses, i.e., accesses that violate the facility’s security and privacy policies. This process is inefficient, as each suspicious access has to be reviewed by a security expert, and is purely retrospective, as it occurs after damage may have been incurred. This motivates automated approaches based on machine learning using historical data. Previous attempts at such a system have successfully applied supervised learning models to this end, such as SVMs and logistic regression. While providing benefits over manual auditing, these approaches ignore the identity of the users and patients involved in a record access. Therefore, they cannot exploit the fact that a patient whose record was previously involved in a violation has an increased risk of being involved in a future violation. Motivated by this, in this paper, we propose a collaborative filtering inspired approach to predicting inappropriate accesses. Our solution integrates both explicit and latent features for staff and patients, the latter acting as a personalized “finger-print” based on historical access patterns. The proposed method, when applied to real EHR access data from two tertiary hospitals and a file-access dataset from Amazon, shows not only significantly improved performance compared to existing methods, but also provides insights as to what indicates an inappropriate access. PMID:24683293

  19. 76 FR 52991 - Renewal of Advisory Committee on Electronic Records Archives

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-24

    ... RECORDS ADMINISTRATION Renewal of Advisory Committee on Electronic Records Archives AGENCY: National... Administration's (NARA) Advisory Committee on Electronic Records Archives. In accordance with Office of... Electronic Records Archives in NARA's ceiling of discretionary advisory committees. FOR FURTHER...

  20. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... the Government's use of computers enhances the public's access to Government information. This section... to view such records in hard copy or to access the Internet via the BBG's computer, please contact... with the operations of the agency or the agency's use of its computers, we will consider the effort...

  1. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... the Government's use of computers enhances the public's access to Government information. This section... to view such records in hard copy or to access the Internet via the BBG's computer, please contact... with the operations of the agency or the agency's use of its computers, we will consider the effort...

  2. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... the Government's use of computers enhances the public's access to Government information. This section... to view such records in hard copy or to access the Internet via the BBG's computer, please contact... with the operations of the agency or the agency's use of its computers, we will consider the effort...

  3. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... the Government's use of computers enhances the public's access to Government information. This section... to view such records in hard copy or to access the Internet via the BBG's computer, please contact... with the operations of the agency or the agency's use of its computers, we will consider the effort...

  4. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... the Government's use of computers enhances the public's access to Government information. This section... to view such records in hard copy or to access the Internet via the BBG's computer, please contact... with the operations of the agency or the agency's use of its computers, we will consider the effort...

  5. Relevance of the electronic computer to hospital medical records.

    PubMed

    Mitchell, J H

    1969-10-18

    During the past 30 years an "information explosion" has completely changed patterns of illness. Unit files of individual patients have become so large that they are increasingly difficult both to store physically and to assimilate mentally. We have reached a communications barriers which poses a major threat to the efficient practice of clinical medicine.At the same time a new kind of machine, the electronic digital computer, which was invented only 26 years ago, has already come to dominate large areas of military, scientific, commercial, and industrial activity. Its supremacy rests on its ability to perform any data procedure automatically and incredibly quickly.Computers are being employed in clinical medicine in hospitals for various purposes. They can act as arithmetic calculators, they can process and analyse output from recording devices, and they can make possible the automation of various machine systems.However, in the field of case records their role is much less well defined, for here the organization of data as a preliminary to computer input is the real stumbling-block. Data banks of retrospective selected clinical information have been in operation in some centres for a number of years. Attempts are now being made to design computerized "total information systems" to replace conventional paper records, and the possibility of automated diagnosis is being seriously discussed.In my view, however, the medical profession is in danger of being dazzled by optimistic claims about the usefulness of computers in case record processing. The solution to the present problems of record storage and handling is very simple, and does not involve computerization.

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

    PubMed Central

    Meigs, Stephen L.; Solomon, Michael

    2016-01-01

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

  7. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-1235 of this subchapter; (b) Integrate records management and preservation considerations into the... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT...

  8. A personally controlled electronic health record for Australia

    PubMed Central

    Pearce, Christopher; Bainbridge, Michael

    2014-01-01

    Objective On July 1, 2012 Australia launched a personally controlled electronic health record (PCEHR) designed around the needs of consumers. Using a distributed model and leveraging key component national eHealth infrastructure, the PCEHR is designed to enable sharing of any health information about a patient with them and any other health practitioner involved in their care to whom the patient allows access. This paper discusses the consumer-facing part of the program. Method Design of the system was through stakeholder consultation and the development of detailed requirements, followed by clinical design assurance. Results Patients are able to access any posted information through a web-accessible ‘consumer portal.’ Within the portal they are able to assert access controls on all or part of their record. The portal includes areas for consumers to record their own personal information. Discussion The PCEHR has the potential to transform the ability of patients to actively engage in their own healthcare, and to enable the emerging partnership model of health and healthcare in medicine. The ability to access health information traditionally kept within the closed walls of institutions also raises challenges for the profession, both in the language clinicians choose and the ethical issues raised by the changed roles and responsibilities. Conclusions The PCEHR is aimed at connecting all participants and their interventions, and is intended to become a system-wide activity. PMID:24650635

  9. System Synchronizes Recordings from Separated Video Cameras

    NASA Technical Reports Server (NTRS)

    Nail, William; Nail, William L.; Nail, Jasper M.; Le, Doung T.

    2009-01-01

    A system of electronic hardware and software for synchronizing recordings from multiple, physically separated video cameras is being developed, primarily for use in multiple-look-angle video production. The system, the time code used in the system, and the underlying method of synchronization upon which the design of the system is based are denoted generally by the term "Geo-TimeCode(TradeMark)." The system is embodied mostly in compact, lightweight, portable units (see figure) denoted video time-code units (VTUs) - one VTU for each video camera. The system is scalable in that any number of camera recordings can be synchronized. The estimated retail price per unit would be about $350 (in 2006 dollars). The need for this or another synchronization system external to video cameras arises because most video cameras do not include internal means for maintaining synchronization with other video cameras. Unlike prior video-camera-synchronization systems, this system does not depend on continuous cable or radio links between cameras (however, it does depend on occasional cable links lasting a few seconds). Also, whereas the time codes used in prior video-camera-synchronization systems typically repeat after 24 hours, the time code used in this system does not repeat for slightly more than 136 years; hence, this system is much better suited for long-term deployment of multiple cameras.

  10. An assessment of PKI and networked electronic patient record system: lessons learned from real patient data exchange at the platform of OCHIS (Osaka Community Healthcare Information System).

    PubMed

    Takeda, Hiroshi; Matsumura, Yasushi; Kuwata, Shigeki; Nakano, Hirohiko; Shanmai, Ji; Qiyan, Zhang; Yufen, Chen; Kusuoka, Hideo; Matsuoka, Masaki

    2004-03-31

    To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.

  11. Use of Electronic Health Records in Residential Care Communities

    MedlinePlus

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

  12. Longevity of Electronic/Digital Records: An Annotated Bibliography

    SciTech Connect

    Deken, J

    2004-03-02

    Current resources, publications, web sites and projects on the longevity and preservation of electronic/digital records are provided, along with brief comments about sites and publications of particular relevance and interest.

  13. 75 FR 71090 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... officer, ATTN: SAF/XCPPI, 1800 Air Force Pentagon, Washington, DC 20330-1800, Mr. Charles J. Shedrick, 703... electronic records for 6 years and 3 months after cutoff. System manager(s) and address: Program Manager,...

  14. Archetype Development Process of Electronic Health Record of Minas Gerais.

    PubMed

    Abreu Maia, Thais; Fernandes De Muylder, Cristiana; Mendonça Queiroga, Rodrigo

    2015-01-01

    The Electronic Health Record (EHR) supports health systems and aims to reduce fragmentation, which will enable continuity of patient care. The paper's main objective is to define the steps, roles and artifacts for an archetype development process (ADP) for the EHR at the Brazilian National Health System (SUS) in the State of Minas Gerais (MG). This study was conducted using qualitative analysis based upon an applied case. It had an exploratory purpose metodologically defined in four stages: literature review; descriptive comparison; proposition of an archetype development process and proof of concept. The proof of concept showed that the proposed ADP ensures the archetype quality and supports the semantic interoperability in SUS to improve clinical safety and the continuity of patient care.

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

    PubMed Central

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

    2015-01-01

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

  16. Leveraging the Cloud for Electronic Health Record Access

    PubMed Central

    Coats, Brian; Acharya, Subrata

    2014-01-01

    Healthcare providers are under increasing pressure to enable widespread access to their electronic health record (EHR) systems for the patients they serve; the meaningful use incentive programs are perhaps the most significant driver encouraging this access. Elsewhere, the cloud has become extremely efficient and successful at establishing digital identities for individuals and making them interoperable across heterogeneous systems. As the healthcare industry contemplates providing patients access to their EHRs, the solution should leverage existing cloud investment, not duplicate it. Through an analysis of industry standards and similar work being performed in other industries, a trust framework has been derived for exchanging identity information. This research lays out a comprehensive structure that healthcare providers can easily use to integrate their EHRs with the cloud for identity validation, while meeting compliance guidelines for security and privacy. Further, this research has been implemented at a large regional hospital, yielding immediate and tangible improvements. PMID:24808814

  17. Leveraging the cloud for electronic health record access.

    PubMed

    Coats, Brian; Acharya, Subrata

    2014-01-01

    Healthcare providers are under increasing pressure to enable widespread access to their electronic health record (EHR) systems for the patients they serve; the meaningful use incentive programs are perhaps the most significant driver encouraging this access. Elsewhere, the cloud has become extremely efficient and successful at establishing digital identities for individuals and making them interoperable across heterogeneous systems. As the healthcare industry contemplates providing patients access to their EHRs, the solution should leverage existing cloud investment, not duplicate it. Through an analysis of industry standards and similar work being performed in other industries, a trust framework has been derived for exchanging identity information. This research lays out a comprehensive structure that healthcare providers can easily use to integrate their EHRs with the cloud for identity validation, while meeting compliance guidelines for security and privacy. Further, this research has been implemented at a large regional hospital, yielding immediate and tangible improvements. PMID:24808814

  18. 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…

  19. Admissibility of Electronically Filed Federal Records as Evidence.

    ERIC Educational Resources Information Center

    Government Information Quarterly, 1992

    1992-01-01

    Presents guidelines prepared by Department of Justice Management Division staff to provide an understanding of the rules of evidence as they apply to electronically filed records and ensure that appropriate agency procedures are instituted in creating and maintaining such records. Hearsay, authentication, and the laying of a proper foundation are…

  20. Next-generation phenotyping of electronic health records

    PubMed Central

    Hripcsak, George; Albers, David J

    2013-01-01

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

  1. A patient-controlled journal for an electronic medical record: issues and challenges.

    PubMed

    Wald, Jonathan S; Middleton, Blackford; Bloom, Amy; Walmsley, Dan; Gleason, Mary; Nelson, Elizabeth; Li, Qi; Epstein, Marianna; Volk, Lynn; Bates, David W

    2004-01-01

    Partners Healthcare System, Boston, MA, has developed a patient Web portal that features a patient-controlled electronic "journal" to allow patients to interact with their physician's electronic medical record. Patients can view and respond to health reminders, critique electronic chart information maintained by their doctor's office, enter additional clinical information, and prepare information summaries before an office visit. Creating shared information resources to support a collaborative care model required analysis of the business, architectural, and workflow requirements of the patient-controlled clinical portal and the physician-controlled electronic medical record system. In this paper we describe the challenges in aligning the two systems and serving the different user groups. Coupling the Patient Gateway system, serving over 8700 patients of 90 physicians as of September, 2003, with the Longitudinal Medical Record system, serving over 4000 physicians, has required a clear definition of user goals and workflow, well-defined interfaces, and careful consideration of system assumptions to succeed.

  2. Learning Relational Policies from Electronic Health Record Access Logs

    PubMed Central

    Malin, Bradley; Nyemba, Steve; Paulett, John

    2011-01-01

    Modern healthcare organizations (HCOs) are composed of complex dynamic teams to ensure clinical operations are executed in a quick and competent manner. At the same time, the fluid nature of such environments hinders administrators' efforts to define access control policies that appropriately balance patient privacy and healthcare functions. Manual efforts to define these policies are labor-intensive and error-prone, often resulting in systems that endow certain care providers with overly broad access to patients' medical records while restricting other providers from legitimate and timely use. In this work, we propose an alternative method to generate these policies by automatically mining usage patterns from electronic health record (EHR) systems. EHR systems are increasingly being integrated into clinical environments and our approach is designed to be generalizable across HCOs, thus assisting in the design and evaluation of local access control policies. Our technique, which is grounded in data mining and social network analysis theory, extracts a statistical model of the organization from the access logs of its EHRs. In doing so, our approach enables the review of predefined policies, as well as the discovery of unknown behaviors. We evaluate our approach with five months of access logs from the Vanderbilt University Medical Center and confirm the existence of stable social structures and intuitive business operations. Additionally, we demonstrate that there is significant turnover in the interactions between users in the HCO and that policies learned at the department level afford greater stability over time. PMID:21277996

  3. Aerial Photography Summary Record System

    USGS Publications Warehouse

    ,

    1998-01-01

    The Aerial Photography Summary Record System (APSRS) describes aerial photography projects that meet specified criteria over a given geographic area of the United States and its territories. Aerial photographs are an important tool in cartography and a number of other professions. Land use planners, real estate developers, lawyers, environmental specialists, and many other professionals rely on detailed and timely aerial photographs. Until 1975, there was no systematic approach to locate an aerial photograph, or series of photographs, quickly and easily. In that year, the U.S. Geological Survey (USGS) inaugurated the APSRS, which has become a standard reference for users of aerial photographs.

  4. How to choose an electronic medical record.

    PubMed

    Lanier, Bob G

    2006-01-01

    I chose a Windows-based file system over a server-based system with a proprietary database, or a web-based system which has both a proprietary database and which also required a full time Internet connection. My reasoning was that I found it uncomplicated. I was familiar with the Windows interface and it required little effort to enter my existing data and was simple to operate the system. If one laptop crashes, my other computers still work. I don't fear failure of an Internet connection source, a modem or a server, power surges or other possible single points of failure that might prevent my patient care. I can incorporate all document types, I can update jump drives with any needed medical information. I can share information instantly with other systems. I can store my own data in a flexible and open format. I have no maintenance contract and I can make changes in my system or can even change vendors at any time. Last but certainly not least, I do not need a highly trained technical staff to operate or maintain our system.

  5. Role of information systems in controlling costs: the electronic medical record (EMR) and the high-performance computing and communications (HPCC) efforts

    NASA Astrophysics Data System (ADS)

    Kun, Luis G.

    1994-12-01

    On October 18, 1991, the IEEE-USA produced an entity statement which endorsed the vital importance of the High Performance Computer and Communications Act of 1991 (HPCC) and called for the rapid implementation of all its elements. Efforts are now underway to develop a Computer Based Patient Record (CBPR), the National Information Infrastructure (NII) as part of the HPCC, and the so-called `Patient Card'. Multiple legislative initiatives which address these and related information technology issues are pending in Congress. Clearly, a national information system will greatly affect the way health care delivery is provided to the United States public. Timely and reliable information represents a critical element in any initiative to reform the health care system as well as to protect and improve the health of every person. Appropriately used, information technologies offer a vital means of improving the quality of patient care, increasing access to universal care and lowering overall costs within a national health care program. Health care reform legislation should reflect increased budgetary support and a legal mandate for the creation of a national health care information system by: (1) constructing a National Information Infrastructure; (2) building a Computer Based Patient Record System; (3) bringing the collective resources of our National Laboratories to bear in developing and implementing the NII and CBPR, as well as a security system with which to safeguard the privacy rights of patients and the physician-patient privilege; and (4) utilizing Government (e.g. DOD, DOE) capabilities (technology and human resources) to maximize resource utilization, create new jobs and accelerate technology transfer to address health care issues.

  6. 14 CFR 221.300 - Discontinuation of electronic tariff system.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Discontinuation of electronic tariff system... of electronic tariff system. In the event that the electronic tariff system is discontinued, or the source of the data is changed, or a filer discontinues its business, all electronic data records prior...

  7. 14 CFR 221.300 - Discontinuation of electronic tariff system.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Discontinuation of electronic tariff system... of electronic tariff system. In the event that the electronic tariff system is discontinued, or the source of the data is changed, or a filer discontinues its business, all electronic data records prior...

  8. Cooling system for electronic components

    DOEpatents

    Anderl, William James; Colgan, Evan George; Gerken, James Dorance; Marroquin, Christopher Michael; Tian, Shurong

    2016-05-17

    Embodiments of the present invention provide for non interruptive fluid cooling of an electronic enclosure. One or more electronic component packages may be removable from a circuit card having a fluid flow system. When installed, the electronic component packages are coincident to and in a thermal relationship with the fluid flow system. If a particular electronic component package becomes non-functional, it may be removed from the electronic enclosure without affecting either the fluid flow system or other neighboring electronic component packages.

  9. Cooling system for electronic components

    SciTech Connect

    Anderl, William James; Colgan, Evan George; Gerken, James Dorance; Marroquin, Christopher Michael; Tian, Shurong

    2015-12-15

    Embodiments of the present invention provide for non interruptive fluid cooling of an electronic enclosure. One or more electronic component packages may be removable from a circuit card having a fluid flow system. When installed, the electronic component packages are coincident to and in a thermal relationship with the fluid flow system. If a particular electronic component package becomes non-functional, it may be removed from the electronic enclosure without affecting either the fluid flow system or other neighboring electronic component packages.

  10. Identification of acute myocardial infarction from electronic healthcare records using different disease coding systems: a validation study in three European countries

    PubMed Central

    Coloma, Preciosa M; Valkhoff, Vera E; Mazzaglia, Giampiero; Nielsson, Malene Schou; Pedersen, Lars; Molokhia, Mariam; Mosseveld, Mees; Morabito, Paolo; Schuemie, Martijn J; van der Lei, Johan; Sturkenboom, Miriam; Trifirò, Gianluca

    2013-01-01

    Objective To evaluate positive predictive value (PPV) of different disease codes and free text in identifying acute myocardial infarction (AMI) from electronic healthcare records (EHRs). Design Validation study of cases of AMI identified from general practitioner records and hospital discharge diagnoses using free text and codes from the International Classification of Primary Care (ICPC), International Classification of Diseases 9th revision-clinical modification (ICD9-CM) and ICD-10th revision (ICD-10). Setting Population-based databases comprising routinely collected data from primary care in Italy and the Netherlands and from secondary care in Denmark from 1996 to 2009. Participants A total of 4 034 232 individuals with 22 428 883 person-years of follow-up contributed to the data, from which 42 774 potential AMI cases were identified. A random sample of 800 cases was subsequently obtained for validation. Main outcome measures PPVs were calculated overall and for each code/free text. ‘Best-case scenario’ and ‘worst-case scenario’ PPVs were calculated, the latter taking into account non-retrievable/non-assessable cases. We further assessed the effects of AMI misclassification on estimates of risk during drug exposure. Results Records of 748 cases (93.5% of sample) were retrieved. ICD-10 codes had a ‘best-case scenario’ PPV of 100% while ICD9-CM codes had a PPV of 96.6% (95% CI 93.2% to 99.9%). ICPC codes had a ‘best-case scenario’ PPV of 75% (95% CI 67.4% to 82.6%) and free text had PPV ranging from 20% to 60%. Corresponding PPVs in the ‘worst-case scenario’ all decreased. Use of codes with lower PPV generally resulted in small changes in AMI risk during drug exposure, but codes with higher PPV resulted in attenuation of risk for positive associations. Conclusions ICD9-CM and ICD-10 codes have good PPV in identifying AMI from EHRs; strategies are necessary to further optimise utility of ICPC codes and free-text search. Use of

  11. Use of electronic medical records in oncology outcomes research.

    PubMed

    Kanas, Gena; Morimoto, Libby; Mowat, Fionna; O'Malley, Cynthia; Fryzek, Jon; Nordyke, Robert

    2010-01-01

    Oncology outcomes research could benefit from the use of an oncology-specific electronic medical record (EMR) network. The benefits and challenges of using EMR in general health research have been investigated; however, the utility of EMR for oncology outcomes research has not been explored. Compared to current available oncology databases and registries, an oncology-specific EMR could provide comprehensive and accurate information on clinical diagnoses, personal and medical histories, planned and actual treatment regimens, and post-treatment outcomes, to address research questions from patients, policy makers, the pharmaceutical industry, and clinicians/researchers. Specific challenges related to structural (eg, interoperability, data format/entry), clinical (eg, maintenance and continuity of records, variety of coding schemes), and research-related (eg, missing data, generalizability, privacy) issues must be addressed when building an oncology-specific EMR system. Researchers should engage with medical professional groups to guide development of EMR systems that would ultimately help improve the quality of cancer care through oncology outcomes research.

  12. Open source electronic health records and chronic disease management

    PubMed Central

    Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

    2014-01-01

    Objective To study and report on the use of open source electronic health records (EHR) to assist with chronic care management within safety net medical settings, such as community health centers (CHC). Methods and Materials The study was conducted by NORC at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to CHC that currently use an open source EHR. Results Two of the sites chosen by NORC were actively using an open source EHR to assist in the redesign of their care delivery system to support more effective chronic disease management. This included incorporating the chronic care model into an CHC and using the EHR to help facilitate its elements, such as care teams for patients, in addition to maintaining health records on indigent populations, such as tuberculosis status on homeless patients. Discussion The ability to modify the open-source EHR to adapt to the CHC environment and leverage the ecosystem of providers and users to assist in this process provided significant advantages in chronic care management. Improvements in diabetes management, controlled hypertension and increases in tuberculosis vaccinations were assisted through the use of these open source systems. Conclusions The flexibility and adaptability of open source EHR demonstrated its utility and viability in the provision of necessary and needed chronic disease care among populations served by CHC. PMID:23813566

  13. Automated methods for the summarization of electronic health records

    PubMed Central

    Elhadad, Noémie

    2015-01-01

    Objectives This review examines work on automated summarization of electronic health record (EHR) data and in particular, individual patient record summarization. We organize the published research and highlight methodological challenges in the area of EHR summarization implementation. Target audience The target audience for this review includes researchers, designers, and informaticians who are concerned about the problem of information overload in the clinical setting as well as both users and developers of clinical summarization systems. Scope Automated summarization has been a long-studied subject in the fields of natural language processing and human–computer interaction, but the translation of summarization and visualization methods to the complexity of the clinical workflow is slow moving. We assess work in aggregating and visualizing patient information with a particular focus on methods for detecting and removing redundancy, describing temporality, determining salience, accounting for missing data, and taking advantage of encoded clinical knowledge. We identify and discuss open challenges critical to the implementation and use of robust EHR summarization systems. PMID:25882031

  14. Electronic health record functionality needed to better support primary care.

    PubMed

    Krist, Alex H; Beasley, John W; Crosson, Jesse C; Kibbe, David C; Klinkman, Michael S; Lehmann, Christoph U; Fox, Chester H; Mitchell, Jason M; Mold, James W; Pace, Wilson D; Peterson, Kevin A; Phillips, Robert L; Post, Robert; Puro, Jon; Raddock, Michael; Simkus, Ray; Waldren, Steven E

    2014-01-01

    Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies. PMID:24431335

  15. Cardiovascular disease documentation and counseling in electronic medical records.

    PubMed

    Bae, Jaeyong; Huerta, Timothy R; Ford, Eric W

    2016-07-01

    The purpose of this paper is to explore the relationship between clinical reminders generated by electronic medical record (EMR) systems and providers giving prevention counseling to patients at-risk for cardiovascular disease (CVD). Data were extracted from the 2012 National Ambulatory Medical Care Survey (NAMCS). Results indicate that the providers routinely using clinical reminders are significantly more likely to document height and weight data to determine risk and provide the recommended counseling to patients that merit the intervention. The findings are important for policymakers and managers that have been promoting the adoption of more sophisticated EMR decision support functionalities across the care delivery spectrum. In particular, the ability to intervene prior to negative health events is an important feature of the movement to improve care quality and reduce costs. PMID:27002255

  16. The University of Washington electronic medical record experience.

    PubMed

    Welton, Nanette J

    2010-07-01

    The Health Sciences Library at the University of Washington initiated and continues to develop a role in the electronic medical record, starting with the development of the first integrated web-based interface, called MINDscape. An Integrated Academic Information Management System (IAIMS) grant in 1992 began the process, which also led to the development of a clinical medical librarian position. Over the years, the librarian's role in the clinical environment became more established, and with the advent of clinical online resources, it offered further opportunities for librarians to provide the expertise needed to incorporate the appropriate resources. The collaborative journey continues as librarians, now able to directly access the EMRs, provide information about what resources to use and where best to place them and design how best to provide notes or feedback to clinicians.

  17. 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. PMID:27522846

  18. Design and Anticipated Outcomes of the eMERGE-PGx Project: A Multi-Center Pilot for Pre-Emptive Pharmacogenomics in Electronic Health Record Systems

    PubMed Central

    Rasmussen-Torvik, Laura J.; Stallings, Sarah C.; Gordon, Adam S.; Almoguera, Berta; Basford, Melissa A.; Bielinski, Suzette J.; Brautbar, Ariel; Brilliant, Murray; Carrell, David S.; Connolly, John; Crosslin, David R.; Doheny, Kimberly F.; Gallego, Carlos J.; Gottesman, Omri; Kim, Daniel Seung; Leppig, Kathleen A.; Li, Rongling; Lin, Simon; Manzi, Shannon; Mejia, Ana R.; Pacheco, Jennifer A.; Pan, Vivian; Pathak, Jyotishman; Perry, Cassandra L.; Peterson, Josh F.; Prows, Cynthia A.; Ralston, James; Rasmussen, Luke V.; Ritchie, Marylyn D.; Sadhasivam, Senthilkumar; Scott, Stuart A.; Smith, Maureen; Vega, Aida; Vinks, Alexander A.; Volpi, Simona; Wolf, Wendy A.; Bottinger, Erwin; Chisholm, Rex L.; Chute, Christopher G.; Haines, Jonathan L.; Harley, John B.; Keating, Brendan; Holm, Ingrid A.; Kullo, Iftikhar J.; Jarvik, Gail P.; Larson, Eric B.; Manolio, Teri; McCarty, Catherine A.; Nickerson, Deborah A.; Scherer, Steven E.; Williams, Marc S.; Roden, Dan M.; Denny, Joshua C.

    2014-01-01

    We describe here the design and initial implementation of the eMERGE-PGx project. eMERGE-PGx, a partnership of the eMERGE and PGRN consortia, has three objectives : 1) Deploy PGRNseq, a next-generation sequencing platform assessing sequence variation in 84 proposed pharmacogenes, in nearly 9,000 patients likely to be prescribed drugs of interest in a 1–3 year timeframe across several clinical sites; 2) Integrate well-established clinically-validated pharmacogenetic genotypes into the electronic health record with associated clinical decision support and assess process and clinical outcomes of implementation; and 3) Develop a repository of pharmacogenetic variants of unknown significance linked to a repository of EHR-based clinical phenotype data for ongoing pharmacogenomics discovery. We describe site-specific project implementation and anticipated products, including genetic variant and phenotype data repositories, novel variant association studies, clinical decision support modules, clinical and process outcomes, approaches to manage incidental findings, and patient and clinician education methods. PMID:24960519

  19. Nurses' Perceptions of Nursing Care Documentation in the Electronic Health Record

    ERIC Educational Resources Information Center

    Jensen, Tracey A.

    2013-01-01

    Electronic health records (EHRs) will soon become the standard for documenting nursing care. The EHR holds the promise of rapid access to complete records of a patient's encounter with the healthcare system. It is the expectation that healthcare providers input essential data that communicates important patient information to support quality…

  20. An imaging informatics-based ePR (electronic patient record) system for providing decision support in evaluating dose optimization in stroke rehabilitation

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Winstein, Carolee; Wang, Ximing; Konersman, Matt; Martinez, Clarisa; Schweighofer, Nicolas

    2012-02-01

    Stroke is one of the major causes of death and disability in America. After stroke, about 65% of survivors still suffer from severe paresis, while rehabilitation treatment strategy after stroke plays an essential role in recovery. Currently, there is a clinical trial (NIH award #HD065438) to determine the optimal dose of rehabilitation for persistent recovery of arm and hand paresis. For DOSE (Dose Optimization Stroke Evaluation), laboratory-based measurements, such as the Wolf Motor Function test, behavioral questionnaires (e.g. Motor Activity Log-MAL), and MR, DTI, and Transcranial Magnetic Stimulation (TMS) imaging studies are planned. Current data collection processes are tedious and reside in various standalone systems including hardcopy forms. In order to improve the efficiency of this clinical trial and facilitate decision support, a web-based imaging informatics system has been implemented together with utilizing mobile devices (eg, iPAD, tablet PC's, laptops) for collecting input data and integrating all multi-media data into a single system. The system aims to provide clinical imaging informatics management and a platform to develop tools to predict the treatment effect based on the imaging studies and the treatment dosage with mathematical models. Since there is a large amount of information to be recorded within the DOSE project, the system provides clinical data entry through mobile device applications thus allowing users to collect data at the point of patient interaction without typing into a desktop computer, which is inconvenient. Imaging analysis tools will also be developed for structural MRI, DTI, and TMS imaging studies that will be integrated within the system and correlated with the clinical and behavioral data. This system provides a research platform for future development of mathematical models to evaluate the differences between prediction and reality and thus improve and refine the models rapidly and efficiently.

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

    PubMed

    Herbert, Valerie M; Connors, Helen

    2016-08-01

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

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

    PubMed

    Herbert, Valerie M; Connors, Helen

    2016-08-01

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

  3. Electronic Nose System Sensors

    NASA Technical Reports Server (NTRS)

    2003-01-01

    The Jet Propulsion Laboratory has designed and built an electronic nose system -- ENose -- to take on the duty of staying alert for smells that could indicate hazardous conditions in a closed spacecraft environment. Its sensors (shown here) are tailored so they conduct electricity differently when an air stream carries a particular chemical across them. JPL has designed and built a 3-pound flight version. The active parts are 32 sensors, each with a different mix of polymers saturated with carbon. When certain chemicals latch onto a sensor, they change how the sensor conducts electricity. This signal tells how much of a compound is in the air. The electronic nose flown aboard STS-95 in 1998 was capable of successfully detecting 10 toxic compounds.

  4. Electronic Nose System

    NASA Technical Reports Server (NTRS)

    2003-01-01

    The Jet Propulsion Laboratory has designed and built an electronic nose system -- ENose -- to take on the duty of staying alert for smells that could indicate hazardous conditions in a closed spacecraft environment. Its sensors are tailored so they conduct electricity differently when an air stream carries a particular chemical across them. JPL has designed and built a 3-pound flight version (shown with palm-size control and data computer). The active parts are 32 sensors, each with a different mix of polymers saturated with carbon. When certain chemicals latch onto a sensor, they change how the sensor conducts electricity. This signal tells how much of a compound is in the air. The electronic nose flown aboard STS-95 in 1998 was capable of successfully detecting 10 toxic compounds.

  5. 20 CFR 345.208 - System records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  6. 36 CFR 1235.44 - What general transfer requirements apply to electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... requirements apply to electronic records? 1235.44 Section 1235.44 Parks, Forests, and Public Property NATIONAL... electronic records? (a) Each agency must retain a copy of permanent electronic records that it transfers to... preservation of the records. (b) For guidance related to the transfer of electronic records other than...

  7. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.22 What are the additional requirements for managing electronic...

  8. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.22 What are the additional requirements for managing electronic...

  9. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.22 What are the additional requirements for managing electronic...

  10. 36 CFR 1235.44 - What general transfer requirements apply to electronic records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... preservation of the records. (b) For guidance related to the transfer of electronic records other than those... requirements apply to electronic records? 1235.44 Section 1235.44 Parks, Forests, and Public Property NATIONAL... electronic records? (a) Each agency must retain a copy of permanent electronic records that it transfers...

  11. 36 CFR 1235.44 - What general transfer requirements apply to electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... continuing preservation of the records. (b) For guidance related to the transfer of electronic records other... requirements apply to electronic records? 1235.44 Section 1235.44 Parks, Forests, and Public Property NATIONAL... apply to electronic records? (a) Each agency must retain a copy of permanent electronic records that...

  12. 36 CFR 1235.44 - What general transfer requirements apply to electronic records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... preservation of the records. (b) For guidance related to the transfer of electronic records other than those... requirements apply to electronic records? 1235.44 Section 1235.44 Parks, Forests, and Public Property NATIONAL... electronic records? (a) Each agency must retain a copy of permanent electronic records that it transfers...

  13. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.22 What are the additional requirements for managing electronic...

  14. 36 CFR 1235.44 - What general transfer requirements apply to electronic records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... preservation of the records. (b) For guidance related to the transfer of electronic records other than those... requirements apply to electronic records? 1235.44 Section 1235.44 Parks, Forests, and Public Property NATIONAL... electronic records? (a) Each agency must retain a copy of permanent electronic records that it transfers...

  15. Portable EGG recording system based on a digital voice recorder.

    PubMed

    Jang, J-K; Shieh, M-J; Kuo, T-S; Jaw, F-S

    2009-01-01

    Cutaneous electrogastrogram (EGG) recording offers the benefit of non-invasive gastrointestinal diagnosis. With long-term ambulatory recording of signals, researchers and clinicians could have more opportunities to investigate and analyse paroxysmal or acute symptoms. A portable EGG system based on a digital voice recorder (DVR) is designed for long-term recording of cutaneous EGG signals. The system consists of electrodes, an EGG amplifier, a modulator, and a DVR. Online monitoring and off-line acquisition of EGG are handled by software. A special design employing an integrated timer circuit is used to modulate the EGG frequency to meet the input requirements of the DVR. This approach involves low supply voltage and low power consumption. Software demodulation is used to simplify the complexity of the system, and is helpful in reducing the size of the portable device. By using surface-mount devices (SMD) and a low-power design, the system is robust, compact, and suitable for long-term portable recording. As a result, researchers can record an ambulatory EGG signal by means of the proposed circuits in conjunction with an up-to-date voice-recording device.

  16. Progress in electronic medical record adoption in Canada

    PubMed Central

    Chang, Feng; Gupta, Nishi

    2015-01-01

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

  17. 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

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

    PubMed

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

    2011-01-01

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

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

    PubMed

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

    2011-01-01

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

  20. User Manuals for a Primary Care Electronic Medical Record System: A Mixed Methods Study of User- and Vendor-Generated Documents

    PubMed Central

    Dow, Rustam; Barnsley, Jan; Tu, Karen; Domb, Sharon; Jadad, Alejandro R.; Lemieux-Charles, Louise

    2015-01-01

    Research problem Tutorials and user manuals are important forms of impersonal support for using software applications including electronic medical records (EMRs). Differences between user- and vendor documentation may indicate support needs, which are not sufficiently addressed by the official documentation, and reveal new elements that may inform the design of tutorials and user manuals. Research question What are the differences between user-generated tutorials and manuals for an EMR and the official user manual from the software vendor? Literature review Effective design of tutorials and user manuals requires careful packaging of information, balance between declarative and procedural texts, an action and task-oriented approach, support for error recognition and recovery, and effective use of visual elements. No previous research compared these elements between formal and informal documents. Methodology We conducted an mixed methods study. Seven tutorials and two manuals for an EMR were collected from three family health teams and compared with the official user manual from the software vendor. Documents were qualitatively analyzed using a framework analysis approach in relation to the principles of technical documentation described above. Subsets of the data were quantitatively analyzed using cross-tabulation to compare the types of error information and visual cues in screen captures between user- and vendor-generated manuals. Results and discussion The user-developed tutorials and manuals differed from the vendor-developed manual in that they contained mostly procedural and not declarative information; were customized to the specific workflow, user roles, and patient characteristics; contained more error information related to work processes than to software usage; and used explicit visual cues on screen captures to help users identify window elements. These findings imply that to support EMR implementation, tutorials and manuals need to be customized and

  1. Effect of introduction of a new electronic anesthesia record (Epic) system on the safety and efficiency of patient care in a gastrointestinal endoscopy suite-comparison with historical cohort

    PubMed Central

    Goudra, B; Singh, PM; Borle, A; Gouda, G

    2016-01-01

    Background: Use of electronic medical record systems has increased in the recent years. Epic is one such system gaining popularity in the USA. Epic is a private company, which invented the electronic documentation system adopted in our hospital. In spite of many presumed advantages, its use is not critically analyzed. Some of the perceived advantages are increased efficiency and protection against litigation as a result of accurate documentation. Materials and Methods: In this study, retrospective data of 305 patients who underwent endoscopic retrograde cholangiopancreatography (wherein electronic charting was used - “Epic group”) were compared with 288 patients who underwent the same procedure with documentation saved on a paper chart (“paper group”). Time of various events involved in the procedure such as anesthesia start, endoscope insertion, endoscope removal, and transfer to the postanesthesia care unit were routinely documented. From this data, the various time durations were calculated. Results: Both “anesthesia start to scope insertion” times and “scope removal to transfer” times were significantly less in the Epic group compared to the paper group. Use of Epic system led to a saving of 4 min of procedure time per patient. However, the mean oxygen saturation was significantly less in the Epic group. Conclusion: In spite of perceived advantages of Epic documentation system, significant hurdles remain with its use. Although the system allows seamless flow of patients, failure to remove all artifacts can lead to errors and become a source of potential litigation hazard. PMID:27051360

  2. Dynamic optometer. [for electronic recording of human lens anterior surface

    NASA Technical Reports Server (NTRS)

    Wilson, D. C.

    1974-01-01

    A dynamic optometer that electronically records the position of the anterior surface of the human lens is described. The geometrical optics of the eye and optometer, and the scattering of light from the lens, are closely examined to determine the optimum conditions for adjustment of the instrument. The light detector and associated electronics are also considered, and the operating conditions for obtaining the best signal-to-noise ratio are determined.

  3. “Big Data” and the Electronic Health Record

    PubMed Central

    Ross, M. K.; Wei, Wei

    2014-01-01

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

  4. Information Discovery on Electronic Health Records Using Authority Flow Techniques

    PubMed Central

    2010-01-01

    Background As the use of electronic health records (EHRs) becomes more widespread, so does the need to search and provide effective information discovery within them. Querying by keyword has emerged as one of the most effective paradigms for searching. Most work in this area is based on traditional Information Retrieval (IR) techniques, where each document is compared individually against the query. We compare the effectiveness of two fundamentally different techniques for keyword search of EHRs. Methods We built two ranking systems. The traditional BM25 system exploits the EHRs' content without regard to association among entities within. The Clinical ObjectRank (CO) system exploits the entities' associations in EHRs using an authority-flow algorithm to discover the most relevant entities. BM25 and CO were deployed on an EHR dataset of the cardiovascular division of Miami Children's Hospital. Using sequences of keywords as queries, sensitivity and specificity were measured by two physicians for a set of 11 queries related to congenital cardiac disease. Results Our pilot evaluation showed that CO outperforms BM25 in terms of sensitivity (65% vs. 38%) by 71% on average, while maintaining the specificity (64% vs. 61%). The evaluation was done by two physicians. Conclusions Authority-flow techniques can greatly improve the detection of relevant information in EHRs and hence deserve further study. PMID:20969780

  5. Public trust and privacy in shared electronic health records.

    PubMed

    Rynning, Elisabeth

    2007-07-01

    The development of information and communication technology in health care, also called eHealth, is expected to improve patient safety and facilitate more efficient use of limited resources. The introduction of electronic health records (EHRs) can make possible immediate, even automatic transfer of patient data, for health care as well as other purposes, across any kind of institutional, regional or national border. Data can thus be shared and used more effectively for quality assurance, disease surveillance, public health monitoring and research. eHealth may also facilitate patient access to health information and medical treatment, and is seen as an effective tool for patient empowerment. At the same time, eHealth solutions may jeopardize both patient safety and patients' rights, unless carefully designed and used with discretion. The success of EHR systems will depend on public trust in their compatibility with fundamental rights, such as privacy and confidentiality. Shared European EHR systems require interoperability not only with regard to technological and semantic standards, but also concerning legal, social and cultural aspects. Since the area of privacy and medical confidentiality is far from harmonized across Europe, we are faced with a diversity that will make fully shared EHR systems a considerable challenge.

  6. 78 FR 52518 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-23

    ... Service is amending a system of records notice, T7335b, entitled ``Business Management Redesign (E-BIZ... comprehensive management information planning system. DATES: This proposed action will be effective on September... of Defense. T7335b System name: Electronic Business-Labor and Accounting Report (E-BIZ)...

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

    PubMed

    Victoroff Md, Michael S

    2012-01-01

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

  8. Quality and Electronic Health Records in Community Health Centers

    ERIC Educational Resources Information Center

    Lesh, Kathryn A.

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  10. Biobanks and Electronic Medical Records: Enabling Cost-Effective Research

    PubMed Central

    Bowton, Erica; Field, Julie R.; Wang, Sunny; Schildcrout, Jonathan S.; Van Driest, Sara L.; Delaney, Jessica T.; Cowan, James; Weeke, Peter; Mosley, Jonathan D.; Wells, Quinn S.; Karnes, Jason H.; Shaffer, Christian; Peterson, Josh F.; Denny, Joshua C.; Roden, Dan M.; Pulley, Jill M.

    2014-01-01

    The use of electronic medical record data linked to biological specimens in health care settings is expected to enable cost-effective and rapid genomic analyses. Here, we present a model that highlights potential advantages for genomic discovery and describe the operational infrastructure that facilitated multiple simultaneous discovery efforts. PMID:24786321

  11. 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…

  12. Thinking About Taking The Leap? Hear From Those Who Did So...and Survived A Case Study: NASA Stennis Space Center Electronic Records Management

    NASA Technical Reports Server (NTRS)

    Albasini, Colby V.

    2008-01-01

    Increased visibility into records management: a) Partnered with NARA to provide electronic records management and Emergency Response training; b) Mandate all civil servants and records personnel attend training.Improve Disaster Recovery: a) TechDoc considered a vital system; b) All electronic documentation and records managed by our system available offsite.

  13. Consumers' Perceptions of Patient-Accessible Electronic Medical Records

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2016-09-19

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

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

    PubMed

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

    2016-09-19

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

  16. Development of Mobile Platform Integrated with Existing Electronic Medical Records

    PubMed Central

    Kim, YoungAh; Kang, Simon; Kim, Kyungduk; Kim, Jun

    2014-01-01

    Objectives This paper describes a mobile Electronic Medical Record (EMR) platform designed to manage and utilize the existing EMR and mobile application with optimized resources. Methods We structured the mEMR to reuse services of retrieval and storage in mobile app environments that have already proven to have no problem working with EMRs. A new mobile architecture-based mobile solution was developed in four steps: the construction of a server and its architecture; screen layout and storyboard making; screen user interface design and development; and a pilot test and step-by-step deployment. This mobile architecture consists of two parts, the server-side area and the client-side area. In the server-side area, it performs the roles of service management for EMR and documents and for information exchange. Furthermore, it performs menu allocation depending on user permission and automatic clinical document architecture document conversion. Results Currently, Severance Hospital operates an iOS-compatible mobile solution based on this mobile architecture and provides stable service without additional resources, dealing with dynamic changes of EMR templates. Conclusions The proposed mobile solution should go hand in hand with the existing EMR system, and it can be a cost-effective solution if a quality EMR system is operated steadily with this solution. Thus, we expect this example to be shared with hospitals that currently plan to deploy mobile solutions. PMID:25152837

  17. 36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for...

  18. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General § 1236.6 What are agency responsibilities for electronic records management? Agencies must:...

  19. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General § 1236.6 What are agency responsibilities for electronic records management? Agencies must:...

  20. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General § 1236.6 What are agency responsibilities for electronic records management? Agencies must:...

  1. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General § 1236.6 What are agency responsibilities for electronic records management? Agencies must:...

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

    PubMed

    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

    2013-10-01

    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.

  3. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 9 2012-07-01 2012-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance...

  4. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance...

  5. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance...

  6. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance...

  7. Electron-beam recording of patterns in chalcogenide films

    NASA Astrophysics Data System (ADS)

    Sergeev, S. A.; Iovu, M. S.; Iaseniuc, O. V.

    2015-02-01

    Thin films of chalcogenide glasses (ChG) of different composition have been used for e-beam recording of diffraction grating structures. The dependencies of diffraction efficiency of gratings on radiation dose were studied. The influence of ChG film composition on diffraction properties of gratings was shown. It was established that the refractive index gratings formed in As2S3 films exhibit high stability during their dark storage. The diffraction efficiency enhancement caused by uniform light irradiation was observed for gratings recorded in As4S3Se3 thin films, doped with Sn. With use of computer-controlled positioning of electron beam both the raster scan and vector patterns were recorded in As2S3 films. In the former case the images from BMP-files were patterned. In the latter case the mosaic of diffraction gratings, producing the multi-beam light diffraction was recorded.

  8. Using Electronic Response Systems in Economics Classes

    ERIC Educational Resources Information Center

    Ghosh, Sucharita; Renna, Francesco

    2009-01-01

    College instructors and students participated in a pilot project at the University of Akron to enhance student learning through the use of a common teaching pedagogy, peer instruction. The teaching pedagogy was supported by the use of technology, an electronic personal response system, which recorded student responses. The authors report their…

  9. Accounting Systems and the Electronic Office.

    ERIC Educational Resources Information Center

    Gafney, Leo

    1986-01-01

    Discusses a systems approach to accounting instruction and examines it from the viewpoint of four components: people (titles and responsibilities, importance of interaction), forms (nonpaper records such as microfiche, floppy disks, hard disks), procedures (for example, electronic funds transfer), and technology (for example, electronic…

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false What records management... Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Records Management and Preservation Considerations for Designing...

  11. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false What records management... Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Records Management and Preservation Considerations for Designing...

  12. 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? PMID:16849913

  13. 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?

  14. Investigation of system integration methods for bubble domain flight recorders

    NASA Technical Reports Server (NTRS)

    Chen, T. T.; Bohning, O. D.

    1975-01-01

    System integration methods for bubble domain flight records are investigated. Bubble memory module packaging and assembly, the control electronics design and construction, field coils, and permanent magnet bias structure design are studied. A small 60-k bit engineering model was built and tested to demonstrate the feasibility of the bubble recorder. Based on the various studies performed, a projection is made on a 50,000,000-bit prototype recorder. It is estimated that the recorder will occupy 190 cubic in., weigh 12 lb, and consume 12 w power when all of its four tracks are operated in parallel at 150 kHz data rate.

  15. Examining the Relationship between Electronic Health Record Interoperability and Quality Management

    ERIC Educational Resources Information Center

    Purcell, Bernice M.

    2013-01-01

    A lack of interoperability impairs data quality among health care providers' electronic health record (EHR) systems. The problem is whether the International Organization for Standardization (ISO) 9000 principles relate to the problem of interoperability in implementation of EHR systems. The purpose of the nonexperimental quantitative…

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

    PubMed Central

    2016-01-01

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

  17. 78 FR 44931 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-25

    .... (February 20, 1996, 61 FR 6427). Dated: July 19, 2013. Aaron Siegel, Alternate OSD Federal Register Liaison...: Space and Naval Warfare Systems Center, 53560 Hull Street, San Diego, CA 92152-5001. Categories of... disposing of records in the system: Storage: Electronic storage media. Retrievability: Data is retrieved...

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

    PubMed

    DeVore, Susan D; Figlioli, Keith

    2010-04-01

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

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

    PubMed

    DeVore, Susan D; Figlioli, Keith

    2010-04-01

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

  20. Modelling and implementing electronic health records in Denmark.

    PubMed

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

    2005-03-01

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

  1. Clinical Research Informatics and Electronic Health Record Data

    PubMed Central

    Horvath, M. M.; Rusincovitch, S. A.

    2014-01-01

    Summary Objectives The goal of this survey is to discuss the impact of the growing availability of electronic health record (EHR) data on the evolving field of Clinical Research Informatics (CRI), which is the union of biomedical research and informatics. Results Major challenges for the use of EHR-derived data for research include the lack of standard methods for ensuring that data quality, completeness, and provenance are sufficient to assess the appropriateness of its use for research. Areas that need continued emphasis include methods for integrating data from heterogeneous sources, guidelines (including explicit phenotype definitions) for using these data in both pragmatic clinical trials and observational investigations, strong data governance to better understand and control quality of enterprise data, and promotion of national standards for representing and using clinical data. Conclusions The use of EHR data has become a priority in CRI. Awareness of underlying clinical data collection processes will be essential in order to leverage these data for clinical research and patient care, and will require multi-disciplinary teams representing clinical research, informatics, and healthcare operations. Considerations for the use of EHR data provide a starting point for practical applications and a CRI research agenda, which will be facilitated by CRI’s key role in the infrastructure of a learning healthcare system. PMID:25123746

  2. An electronic health record-enabled obesity database

    PubMed Central

    2012-01-01

    Background The effectiveness of weight loss therapies is commonly measured using body mass index and other obesity-related variables. Although these data are often stored in electronic health records (EHRs) and potentially very accessible, few studies on obesity and weight loss have used data derived from EHRs. We developed processes for obtaining data from the EHR in order to construct a database on patients undergoing Roux-en-Y gastric bypass (RYGB) surgery. Methods Clinical data obtained as part of standard of care in a bariatric surgery program at an integrated health delivery system were extracted from the EHR and deposited into a data warehouse. Data files were extracted, cleaned, and stored in research datasets. To illustrate the utility of the data, Kaplan-Meier analysis was used to estimate length of post-operative follow-up. Results Demographic, laboratory, medication, co-morbidity, and survey data were obtained from 2028 patients who had undergone RYGB at the same institution since 2004. Pre-and post-operative diagnostic and prescribing information were available on all patients, while survey laboratory data were available on a majority of patients. The number of patients with post-operative laboratory test results varied by test. Based on Kaplan-Meier estimates, over 74% of patients had post-operative weight data available at 4 years. Conclusion A variety of EHR-derived data related to obesity can be efficiently obtained and used to study important outcomes following RYGB. PMID:22640398

  3. Measuring Nursing Value from the Electronic Health Record.

    PubMed

    Welton, John M; Harper, Ellen M

    2016-01-01

    We report the findings of a big data nursing value expert group made up of 14 members of the nursing informatics, leadership, academic and research communities within the United States tasked with 1. Defining nursing value, 2. Developing a common data model and metrics for nursing care value, and 3. Developing nursing business intelligence tools using the nursing value data set. This work is a component of the Big Data and Nursing Knowledge Development conference series sponsored by the University Of Minnesota School Of Nursing. The panel met by conference calls for fourteen 1.5 hour sessions for a total of 21 total hours of interaction from August 2014 through May 2015. Primary deliverables from the bit data expert group were: development and publication of definitions and metrics for nursing value; construction of a common data model to extract key data from electronic health records; and measures of nursing costs and finance to provide a basis for developing nursing business intelligence and analysis systems. PMID:27332163

  4. First steps towards semantic descriptions of electronic laboratory notebook records

    PubMed Central

    2013-01-01

    In order to exploit the vast body of currently inaccessible chemical information held in Electronic Laboratory Notebooks (ELNs) it is necessary not only to make it available but also to develop protocols for discovery, access and ultimately automatic processing. An aim of the Dial-a-Molecule Grand Challenge Network is to be able to draw on the body of accumulated chemical knowledge in order to predict or optimize the outcome of reactions. Accordingly the Network drew up a working group comprising informaticians, software developers and stakeholders from industry and academia to develop protocols and mechanisms to access and process ELN records. The work presented here constitutes the first stage of this process by proposing a tiered metadata system of knowledge, information and processing where each in turn addresses a) discovery, indexing and citation b) context and access to additional information and c) content access and manipulation. A compact set of metadata terms, called the elnItemManifest, has been derived and caters for the knowledge layer of this model. The elnItemManifest has been encoded as an XML schema and some use cases are presented to demonstrate the potential of this approach. PMID:24360292

  5. A critical pathway for electronic medical record selection.

    PubMed

    Holbrook, A; Keshavjee, K; Langton, K; Troyan, S; Millar, S; Olantunji, S; Pray, M; Tytus, R; Ford, P T

    2001-01-01

    Electronic medical records (EMRs) are increasingly becoming a necessary tool in health care. Given their potential to influence every aspect of health care, there has been surprisingly little rigorous research applied to this important piece of emerging health technology. An initial phase of the COMPETE study, which is examining the impact of EMRs on efficiency, quality of care and privacy concerns, involved a rigorous "critical pathway" approach to EMR selection for the study. A multidisciplinary team with clinical, technical and research expertise led an 8-stage evaluation process with direct input from user physicians at each stage. An iterative sequence of review of EMR specifications and features, live product demonstrations, site visits, and negotiations with vendors led to a progressive narrowing of the field of eligible EMR systems. Final scoring was based on 3 main themes of clinical usability, data quality and support/vendor issues. We believe that a rigorous, multidisciplinary process such as this is required to maximize success of any EMR implementation project.

  6. Relationships between Electronic Information Media and Records Management Practices: Results of a Survey of United Nations Organizations. A Rand Note.

    ERIC Educational Resources Information Center

    Bikson, T. K.; Schieber, L.

    A Technical Panel on Electronic Records Management (TP/REM), which was established by the Advisory Committee for the Co-ordination of Information Systems (ACCIS), conducted a survey of existing electronic records management practices and standards related to new information and communication technologies and their interrelationships within the…

  7. The Impact of Electronic Health Records on Healthcare Professional's Beliefs and Attitudes toward Face to Face Communication

    ERIC Educational Resources Information Center

    Nickles, Kenneth Patrick

    2012-01-01

    The impact of electronic health records on healthcare professional's beliefs and attitudes toward face to face communication during patient and provider interactions was examined. Quantitative survey research assessed user attitudes towards an electronic health record system and revealed that healthcare professionals from a wide range of…

  8. Interfacing with the brain using organic electronics (Presentation Recording)

    NASA Astrophysics Data System (ADS)

    Malliaras, George G.

    2015-10-01

    Implantable electrodes are being used for diagnostic purposes, for brain-machine interfaces, and for delivering electrical stimulation to alleviate the symptoms of diseases such as Parkinson's. The field of organic electronics made available devices with a unique combination of attractive properties, including mixed ionic/electronic conduction, mechanical flexibility, enhanced biocompatibility, and capability for drug delivery. I will present examples of organic electrodes, transistors and other devices for recording and stimulation of brain activity and discuss how they can improve our understanding of brain physiology and pathology, and how they can be used to deliver new therapies.

  9. 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.

  10. An implementation case study. Implementation of the Indian Health Service's Resource and Patient Management System Electronic Health Record in the ambulatory care setting at the Phoenix Indian Medical Center.

    PubMed

    Dunnigan, Anthony; John, Karen; Scott, Andrea; Von Bibra, Lynda; Walling, Jeffrey

    2010-01-01

    The Phoenix Indian Medical Center (PIMC) has successfully implemented the Resource and Patient Management System Electronic Health Record (RPMS-EHR) in its Ambulatory Care departments. One-hundred and twenty-six providers use the system for essentially all elements of documentation, ordering, and coding. Implementation of one function at a time, in one clinical area at a time, allowed for focused training and support. Strong departmental leadership and the development of 'super-users' were key elements. Detailed assessments of each clinic prior to implementation were vital, resulting in optimal workstation utilization and a greater understanding of each clinic's unique flow. Each phase saw an increasing reluctance to revert to old paper processes. The success of this implementation has placed pressure on the remainder of the hospital to implement the RPMS-EHR, and has given the informatics team an increased awareness of what resources are required to achieve this result.

  11. Patient clustering with uncoded text in electronic medical records.

    PubMed

    Henao, Ricardo; Murray, Jared; Ginsburg, Geoffrey; Carin, Lawrence; Lucas, Joseph E

    2013-01-01

    We propose a mixture model for text data designed to capture underlying structure in the history of present illness section of electronic medical records data. Additionally, we propose a method to induce bias that leads to more homogeneous sets of diagnoses for patients in each cluster. We apply our model to a collection of electronic records from an emergency department and compare our results to three other relevant models in order to assess performance. Results using standard metrics demonstrate that patient clusters from our model are more homogeneous when compared to others, and qualitative analyses suggest that our approach leads to interpretable patient sub-populations when applied to real data. Finally, we demonstrate an example of our patient clustering model to identify adverse drug events.

  12. Surgeons' perspective of a newly initiated electronic medical record.

    PubMed

    Frazee, Richard; Harmon, Laura; Papaconstantinou, Harry T

    2016-01-01

    The American Recovery and Reinvestment Act mandates "meaningful use" of an electronic health record (EHR) to receive current financial incentives and to avoid future financial penalties. Surgeons' ongoing adoption of an EHR nationally will be influenced by the early experiences of institutions that have made the transition from paper to electronic records. We conducted a survey to query surgeons at our institution regarding their perception of the EHR 3 months after institutional implementation. A total of 59 surveys were obtained from 24 senior staff and 35 residents. Results showed that surgeons believed the EHR was more effective as a billing tool than as a form of clinical documentation and believed the billing was more complete and accurate with the EHR. Surgeons also expressed concern that the EHR would negatively impact patient satisfaction, but in spite of this, they indicated that their personal quality of life was not negatively impacted.

  13. Patient Clustering with Uncoded Text in Electronic Medical Records

    PubMed Central

    Henao, Ricardo; Murray, Jared; Ginsburg, Geoffrey; Carin, Lawrence; Lucas, Joseph E.

    2013-01-01

    We propose a mixture model for text data designed to capture underlying structure in the history of present illness section of electronic medical records data. Additionally, we propose a method to induce bias that leads to more homogeneous sets of diagnoses for patients in each cluster. We apply our model to a collection of electronic records from an emergency department and compare our results to three other relevant models in order to assess performance. Results using standard metrics demonstrate that patient clusters from our model are more homogeneous when compared to others, and qualitative analyses suggest that our approach leads to interpretable patient sub-populations when applied to real data. Finally, we demonstrate an example of our patient clustering model to identify adverse drug events. PMID:24551361

  14. Using the Electronic Health Record in Nursing Research: Challenges and Opportunities.

    PubMed

    Samuels, Joanne G; McGrath, Robert J; Fetzer, Susan J; Mittal, Prashant; Bourgoine, Derek

    2015-10-01

    Changes in the patient record from the paper to the electronic health record format present challenges and opportunities for the nurse researcher. Current use of data from the electronic health record is in a state of flux. Novel data analytic techniques and massive data sets provide new opportunities for nursing science. Realization of a strong electronic data output future relies on meeting challenges of system use and operability, data presentation, and privacy. Nurse researchers need to rethink aspects of proposal development. Joining ongoing national efforts aimed at creating usable data output is encouraged as a means to affect system design. Working to address challenges and embrace opportunities will help grow the science in a way that answers important patient care questions. PMID:25819698

  15. Training providers: beyond the basics of electronic health records

    PubMed Central

    2013-01-01

    Background Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities. Methods Based on feedback from providers and requests for technical support, we developed two classes designed to improve providers’ effectiveness with the electronic health record. Training took place at Kaiser Permanente, Mid-Atlantic States. The classes focused on managing patient-level information using problem lists and medication lists, as well as efficient documentation and chart review. Both classes used the blended learning method, integrating concrete scenarios, hands-on exercises and take-home materials to reinforce class concepts. To evaluate training effectiveness, we used a case–control study with a 1:4 match on pre-training performance. We measured the usage rate of two key electronic health record functions (problem list and medication list management) for six months before and after training. Change scores were compared using the Wilcoxon sign rank test. Results 36 participants and 144 non-participants were included in the training evaluation. Training participants were more likely to manage both medication lists and problem lists after training. Class material is now being incorporated into an enterprise-wide multi-modal training program available to all providers at Kaiser Permanente in the Mid-Atlantic States. Conclusions Ongoing information technology training is well-received by healthcare providers, who expressed a clear preference for additional training. Training improved use of two important electronic health record features that are included as part of the Meaningful Use criteria. PMID:24295150

  16. Report Central: quality reporting tool in an electronic health record.

    PubMed

    Jung, Eunice; Li, Qi; Mangalampalli, Anil; Greim, Julie; Eskin, Michael S; Housman, Dan; Isikoff, Jeremy; Abend, Aaron H; Middleton, Blackford; Einbinder, Jonathan S

    2006-01-01

    Quality reporting tools, integrated with ambulatory electronic health records, can help clinicians and administrators understand performance, manage populations, and improve quality. Report Central is a secure web report delivery tool built on Crystal Reports XItrade mark and ASP.NET technologies. Pilot evaluation of Report Central indicates that clinicians prefer a quality reporting tool that is integrated with our home-grown EHR to support clinical workflow.

  17. Biological Electron Transport Systems

    PubMed Central

    Cowan, Dwaine O.; Pasternak, Gavril; Kaufman, Frank

    1970-01-01

    The solid-state electrical conductivities of a number of ferredoxin model compounds are reported. For one of these compounds, (KFeS2)n, an electron transfer rate for a 25 Å unit is shown to be at least 1 × 108 electrons sec-1. The rate becomes proportionally larger for smaller molecular units. This rapid rate is consistant with a short pipe model for electron transport between two reaction sites. Some of the factors leading to this rapid transfer rate are considered. PMID:5269247

  18. Psychiatry and the meaningful use of electronic health records.

    PubMed

    Triplett, Patrick

    2013-01-01

    Use of electronic health records (EHRs) for psychiatric care is on the rise, although the software and the workflow patterns on which the software has been built are often based on non-psychiatric practices. For providers, the transition from paper psychiatric records to electronic ones requires the development of a new set of skills that includes accommodating the physical presence of the computer and performing various forms of data entry, while still managing to carry out the tasks required for psychiatric practice. These changes alter the dynamic of communication, including elements of assessment and treatment that occur between the psychiatrist and patient. EHRs also raise issues of security of records and greater access by patients to providers and their records. Although EHRs promise an abundance of useful data for research and potentially helpful innovations, they also impose a practice pattern on psychiatry that is made to work largely through the efforts of the physician. EHRs do not enhance interactions in the psychiatric examination room, but instead alter the traditional pattern on which the doctor-patient relationship is founded in psychiatry and through which care is delivered.

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

    PubMed Central

    Denny, Joshua C.

    2012-01-01

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

  20. Method for automatic escalation of access rights to the electronic health record.

    PubMed

    Hansen, Frode Orbeck; Fensli, Rune

    2006-01-01

    In an emergency situation, it can be vital for rescuing personnel to have access to fragmented parts of patients Electronic Health Record (EHR) shared between patients and health care services. In such situations, can Spatial Role Based Access Control combined with measurements of vital sign parameters recorded from a wireless monitoring system used by the patient and patient's physiological situation be used to facilitate for medical personnel automatic access to parts of the EHR.

  1. Everyday ethical dilemmas arising with electronic record use in primary care.

    PubMed

    Balka, Ellen; Tolar, Marianne

    2011-01-01

    The introduction of electronic medical record systems (EMRs) into primary care settings alters work practices, introduces new challenges, and new roles. In the process of integrating an EMR into a primary care setting, clinic staff faced ethical challenges in their everyday work practices resulting from workarounds undertaken to compensate for a poor fit between system design and work practices, issues related to system access, and governance gaps. Examples of these issues are presented, and implications for system design are discussed.

  2. 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…

  3. 77 FR 65416 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National... (NARA) announces a meeting of the Advisory Committee on the Electronic Records Archives (ACERA). The..., and service issues related to the Electronic Records Archives (ERA). This includes, but is not...

  4. 75 FR 63208 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-14

    ... RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National... (NARA) announces a meeting of the Advisory Committee on the Electronic Records Archives (ACERA). The..., and service issues related to the Electronic Records Archives (ERA). This includes, but is not...

  5. 76 FR 19147 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National... Administration (NARA) announces an agenda change for the Advisory Committee on the Electronic Records Archives... to attend must be submitted to the Electronic Records Archives Program at era.program@nara.gov ....

  6. 76 FR 15349 - Advisory Committee on the Electronic Records Archives (ACERA); Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA); Meeting AGENCY... Administration (NARA) announces a meeting of the Advisory Committee on the Electronic Records Archives (ACERA..., mission, and service related to the Electronic Records Archives (ERA). This includes, but is not...

  7. 76 FR 65218 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-20

    ... RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National... (NARA) announces a meeting of the Advisory Committee on the Electronic Records Archives (ACERA). The..., and service issues related to the Electronic Records Archives (ERA). This includes, but is not...

  8. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property... Requirements for Electronic Records § 1236.22 What are the additional requirements for managing electronic mail... requirements for electronic mail records: (1) The names of sender and all addressee(s) and date the message...

  9. [Electronic poison information management system].

    PubMed

    Kabata, Piotr; Waldman, Wojciech; Kaletha, Krystian; Sein Anand, Jacek

    2013-01-01

    We describe deployment of electronic toxicological information database in poison control center of Pomeranian Center of Toxicology. System was based on Google Apps technology, by Google Inc., using electronic, web-based forms and data tables. During first 6 months from system deployment, we used it to archive 1471 poisoning cases, prepare monthly poisoning reports and facilitate statistical analysis of data. Electronic database usage made Poison Center work much easier. PMID:24466697

  10. [Electronic poison information management system].

    PubMed

    Kabata, Piotr; Waldman, Wojciech; Kaletha, Krystian; Sein Anand, Jacek

    2013-01-01

    We describe deployment of electronic toxicological information database in poison control center of Pomeranian Center of Toxicology. System was based on Google Apps technology, by Google Inc., using electronic, web-based forms and data tables. During first 6 months from system deployment, we used it to archive 1471 poisoning cases, prepare monthly poisoning reports and facilitate statistical analysis of data. Electronic database usage made Poison Center work much easier.

  11. Magnetic Thin Films for Perpendicular Magnetic Recording Systems

    NASA Astrophysics Data System (ADS)

    Sugiyama, Atsushi; Hachisu, Takuma; Osaka, Tetsuya

    In the advanced information society of today, information storage technology, which helps to store a mass of electronic data and offers high-speed random access to the data, is indispensable. Against this background, hard disk drives (HDD), which are magnetic recording devices, have gained in importance because of their advantages in capacity, speed, reliability, and production cost. These days, the uses of HDD extend not only to personal computers and network servers but also to consumer electronics products such as personal video recorders, portable music players, car navigation systems, video games, video cameras, and personal digital assistances.

  12. 14 CFR § 1212.605 - Safeguarding information in systems of records.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... ADMINISTRATION PRIVACY ACT-NASA REGULATIONS Instructions for NASA Employees § 1212.605 Safeguarding information in systems of records. (a) Safeguards appropriate for a NASA system of records shall be developed by... Technology Security Officer for electronic records maintained in automated systems. Safeguards must...

  13. Code Status and Resuscitation Options in the Electronic Health Record

    PubMed Central

    Bhatia, Haresh L.; Patel, Neal R.; Choma, Neesha N.; Grande, Jonathan; Giuse, Dario A.; Lehmann, Christoph U.

    2014-01-01

    Aim The advance discussion and documentation of code-status is important in preventing undesired cardiopulmonary resuscitation and related End of Life interventions. Code-status documentation remains infrequent and paper-based, which limits its usefulness. This study evaluates a tool to document code-status in the electronic health records at a large teaching hospital, and analyzes the corresponding data. Methods Encounter data for patients admitted to the Medical Center were collected over a period of 12 months (01-APR-2012 – 31-MAR-2013) and the code-status attribute was tracked for individual patients. The code-status data were analyzed separately for adult and pediatric patient populations. We considered 131,399 encounters for 83,248 adult patients and 80,778 encounters for 55,656 pediatric patients in this study. Results 71% of the adult patients and 30% of the pediatric patients studied had a documented code-status. Age and severity of illness influenced the decision to document code-status. Demographics such as gender, race, ethnicity, and proximity of primary residence were also associated with the documentation of code-status. Conclusion Absence of a recorded code-status may result in unnecessary interventions. Code-status in paper charts may be difficult to access in cardiopulmonary arrest situations and may result in unnecessary and unwanted interventions and procedures. Documentation of Code-status in electronic records creates a readily available reference for care providers. PMID:25447035

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

    ERIC Educational Resources Information Center

    Fareed, Naleef

    2013-01-01

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

  15. 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…

  16. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  17. 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…

  18. 76 FR 58786 - Privacy Act of 1974; Systems of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-22

    ... ] and computer printouts are controlled by limited-access facilities and lockable containers. Access to electronic means is limited and controlled by computer password protection. Retention and disposal: Records..., Department of Defense. GNSA 16 System name: NSA/CSS Drug Testing Program (October 1, 2008, 73 FR...

  19. 76 FR 79216 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-21

    ... include: (1) Personal identification data; (2) time usage data; (3) electronic message data, including... in the Federal Register, 70 FR 69594 (Nov. 16, 2005), with a revision to the routine uses 72 FR 3410... Records'' section, the Bureau clarifies that the system collects personal identification information...

  20. Electronic heterodyne recording and processing of optical holograms using phase modulated reference waves

    NASA Technical Reports Server (NTRS)

    Decker, A. J.; Pao, Y.-H.; Claspy, P. C.

    1978-01-01

    The use of a phase-modulated reference wave for the electronic heterodyne recording and processing of a hologram is described. Heterodyne recording is used to eliminate the self-interference terms of a hologram and to create a Leith-Upatnieks hologram with coaxial object and reference waves. Phase modulation is also shown to be the foundation of a multiple-view hologram system. When combined with hologram scale transformations, heterodyne recording is the key to general optical processing. Spatial filtering is treated as an example.

  1. Performance analysis of distributed and centralized models for electronic medical record exchanges.

    PubMed

    Huang, Ean-Wen; Lee, Chiung-San; Jiang, Wey-Wen; Chiou, Shwu-Fen; Liu, Fei-Ying; Liou, Der-Ming

    2007-01-01

    Electronic medical record exchanges can save time and reduce cost by eliminating redundant data and typing errors. The major steps of record exchange consist of querying information from database, encoding data into messages, and sending and decoding messages. Three medical-record-exchange models were proposed in the past, including the distributed, centralized, and indexed models. In this paper, the queuing theory is applied to evaluate the performance of the three models. We estimate the service time for each queue of the CPU, database and network, and predict the response time, probable bottlenecks and system capacities of each model.

  2. Effectiveness of an electronic inpatient medication record in reducing medication errors in Singapore.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2014-06-01

    This study examined the effectiveness of an inpatient electronic medication record system in reducing medication errors in Singaporean hospitals. This pre- and post-intervention study involving a control group was undertaken in two Singaporean acute care hospitals. In one hospital the inpatient electronic medication record system was implemented while in another hospital the paper-based medication record system was used. The mean incidence difference in medication errors of 0.06 between pre-intervention (0.72 per 1000 patient days) and post-intervention (0.78 per 1000 patient days) for the two hospitals was not statistically significant (95%, CI: [0.26, 0.20]). The mean incidence differences in medication errors relating to prescription, dispensing, and administration were also not statistically different. Common system failures involved a lack of medication knowledge by health professionals and a lack of a systematic approach in identifying correct dosages. There was no difference in the incidence of medication errors following the introduction of the electronic medication record system. More work is needed on how this system can reduce medication error rates and improve medication safety.

  3. Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: United States, 2001-2011.

    PubMed

    Hsiao, Chun-Ju; Hing, Esther; Socey, Thomas C; Cai, Bill

    2011-11-01

    An increasing trend in EMR/EHR system use among office-based physicians was noted from 2001 through preliminary 2011 estimates. In 2011, the NAMCS mail survey showed about 57% of office-based physicians used any EMR/EHR system, a 12% increase from the 2010 estimate. Between 2010 and 2011, the percentage of physicians who reported having systems meeting the criteria for a basic system increased 36%. Adoption of EMR/EHR systems varied greatly by state. In 2011, the percentage of physicians using any EMR/EHR system ranged from 40% in Louisiana to 84% in North Dakota. Compared with the national average, 3 states had a significantly lower percentage of office-based physicians using any EMR/EHR system, and 11 states had a significantly higher percentage. The percentage of physicians having a system that met the criteria for a basic system ranged from 16% in New Jersey to 61% in Minnesota. Compared with the national average, six states had a significantly lower percentage of office-based physicians with a basic system, and eight states had a significantly higher percentage. In 2011, 52% of physicians reported intending to apply for the Medicare or Medicaid EHR incentive payments, a 26% increase from 2010. In 2010, interest among physicians in applying for meaningful use incentive payments was similar to the national average (41%) across most states. In only four states (Alaska, New York, North Dakota, and West Virginia) and the District of Columbia was the percentage lower than the national average. To qualify for Stage 1 meaningful use incentive payments, eligible physicians need to meet all 15 Stage 1 Core Set objectives and 5 of 10 Menu Set objectives, using certified EHR systems (see "Definitions"). In this report, estimates of physicians’ readiness to meet Stage 1 Core Set meaningful use measures were limited to data collected on the computerized functions needed to meet eight Stage 1 objectives. A previous study found that 15% of physicians eligible to apply for

  4. Integration of electronic patient record context with message context.

    PubMed

    De Clercq, Etienne; Bangels, Marc; France, Francis Roger

    2004-01-01

    A methodology to construct specific messages with clear objectives inside clinical processes, while simultaneously including contextual information, remains a problem today. This paper addresses the issue of combining specific message context (process driven) with the context of a patient record (patient centered). In Belgium, simplified conceptual models for Electronic Patient Record (EPR) architecture and for message architecture, based on previous comprehensive and international work, have been produced, validated and mapped into an integrated message format. The resulting model described in this paper highlights the main conceptual links between both basic models: at the action level and at the Transaction level. Using XML, some parts of the model have already been implemented in various national projects. Key lessons learned may be imported at the international level. PMID:15360968

  5. Sharing electronic medical records across multiple heterogeneous and competing institutions.

    PubMed Central

    Kohane, I. S.; van Wingerde, F. J.; Fackler, J. C.; Cimino, C.; Kilbridge, P.; Murphy, S.; Chueh, H.; Rind, D.; Safran, C.; Barnett, O.; Szolovits, P.

    1996-01-01

    Most early reports of implemented World-Wide Web (W3) medical record systems describe single institution architectures. We describe W3-EMRS, a multi-institutional architecture, and its implementation. Thorny problems in data sharing underlined by the W3-EMRS project are reviewed. PMID:8947738

  6. Ultrasonic recording system without intrinsic limits.

    PubMed

    Andreassen, Tórur; Surlykke, Annemarie; Hallam, John; Brandt, David

    2013-06-01

    Today state-of-the-art bioacoustic research requires high-sample-rate, multi-channel, and often long-term recording systems. Commercial systems are very costly. This paper proposes and demonstrates an ultrasonic recording system design that is arbitrarily scalable. The system is modular and based on retail components and open source software/hardware. Each module has four microphones and modules can be combined to extend the coverage area, obtain higher spatial recording resolution, and/or add recording redundancy. The system is designed to have no inherent scalability limits. The system has been deployed in four different test settings. The first setup tests the system's ability to make medium-term recordings (1 to 2 min) with many microphones. The second setup tests the robustness of the system, being deployed throughout the Danish winter with only minor issues. The third setup integrates the system in a mobile robot as an echolocating guidance system, while the fourth setup demonstrates full-spectrum transducer calibration. In most respects this system's hardware specification surpasses all competitors on the market at a quarter of the price. Tests demonstrate that large deployments are feasible and accurate ultrasonic measurements can be obtained. PMID:23742354

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

    PubMed

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

    2016-06-01

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

  8. Electronic recording of holograms with applications to holographic displays

    NASA Technical Reports Server (NTRS)

    Claspy, P. C.; Merat, F. L.

    1979-01-01

    The paper describes an electronic heterodyne recording which uses electrooptic modulation to introduce a sinusoidal phase shift between the object and reference wave. The resulting temporally modulated holographic interference pattern is scanned by a commercial image dissector camera, and the rejection of the self-interference terms is accomplished by heterodyne detection at the camera output. The electrical signal representing this processed hologram can then be used to modify the properties of a liquid crystal light valve or a similar device. Such display devices transform the displayed interference pattern into a phase modulated wave front rendering a three-dimensional image.

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

    PubMed

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

    2016-06-01

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

  10. 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.

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

    PubMed

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

    2016-01-01

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

  12. Automated mapping of pharmacy orders from two electronic health record systems to RxNorm within the STRIDE clinical data warehouse.

    PubMed

    Hernandez, Penni; Podchiyska, Tanya; Weber, Susan; Ferris, Todd; Lowe, Henry

    2009-11-14

    The Stanford Translational Research Integrated Database Environment (STRIDE) clinical data warehouse integrates medication information from two Stanford hospitals that use different drug representation systems. To merge this pharmacy data into a single, standards-based model supporting research we developed an algorithm to map HL7 pharmacy orders to RxNorm concepts. A formal evaluation of this algorithm on 1.5 million pharmacy orders showed that the system could accurately assign pharmacy orders in over 96% of cases. This paper describes the algorithm and discusses some of the causes of failures in mapping to RxNorm.

  13. Data Stewardship: Managing Personally Identifiable Information in Electronic Student Education Records. SLDS Technical Brief 2. NCES 2011-602

    ERIC Educational Resources Information Center

    National Center for Education Statistics, 2010

    2010-01-01

    The growth of electronic student data in America's education system has focused attention on the ways these data are collected, processed, stored, and used. The use of records in Statewide Longitudinal Data Systems to follow the progress of individual students over time requires maintaining student education records that include information that…

  14. Ethics and the electronic health record in dental school clinics.

    PubMed

    Cederberg, Robert A; Valenza, John A

    2012-05-01

    Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. However, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solutions for the management of ethical concerns related to EHRs in dental schools.

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2012-01-01

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

  17. A CORBA-based integration of distributed electronic healthcare records using the synapses approach.

    PubMed

    Grimson, J; Grimson, W; Berry, D; Stephens, G; Felton, E; Kalra, D; Toussaint, P; Weier, O W

    1998-09-01

    The ability to exchange in a meaningful, secure, and simple fashion relevant healthcare data about patients is seen as vital in the context of efficient and cost-effective shared or team-based care. The electronic healthcare record (EHCR) lies at the heart of this information exchange, and it follows that there is an urgent need to address the ability to share EHCR's or parts of records between carers and across distributed health information systems. This paper presents the Synapses approach to sharing based on a standardized shared record, the Federated Healthcare Record, which is implemented in an open and flexible manner using the Common Object Request Broker Architecture (CORBA). The architecture of the Federated Healthcare Record is based on the architecture proposed by the Technical Committee 251 of the European Committee for Standardization.

  18. 65 FR 8669 - Technical Implementation of Electronic Records and Electronic Signatures; Public Meeting and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2000-02-22

    ... Records and Electronic Signatures; Public Meeting and Request for Presentation Abstracts AGENCY: Food and... a presentation at this meeting, send a brief abstract (no longer than one page), along with the... abstracts and speaker information materials, and presentation handouts upon completion of the meeting....

  19. Assessment of the Need to Integrate Academic Electronic Medical Records Into the Undergraduate Clinical Practicum: A Focus Group Interview.

    PubMed

    Choi, Mona; Park, Joon Ho; Lee, Hyeong Suk

    2016-06-01

    As healthcare systems demand that nurses be competent in using electronic medical records for patient care, the integration of electronic medical records into nursing curricula has become necessary. The purpose of this study was to explore how students, new nurses, clinical instructors, and faculty perceive the integration of academic electronic medical records into the undergraduate clinical practicum. From January to February 2014, four focus group interviews with 18 participants were conducted based on purposive sampling. Content analysis was used on the unabridged transcripts to extract themes and develop meaningful categories. Three major themes and eight subthemes were revealed from the focus group interviews. The major themes were "electronic medical record as a learning tool for clinical practicum," "essential functions of academic electronic medical records," and "expected outcomes of academic electronic medical record." Participants expected academic electronic medical records to enhance students' nursing informatics competencies. The findings of this study can inform the process of developing academic electronic medical records for clinical practicum, which will then augment students' informatics competencies. PMID:27081757

  20. Influence of electron dose rate on electron counting images recorded with the K2 camera.

    PubMed

    Li, Xueming; Zheng, Shawn Q; Egami, Kiyoshi; Agard, David A; Cheng, Yifan

    2013-11-01

    A recent technological breakthrough in electron cryomicroscopy (cryoEM) is the development of direct electron detection cameras for data acquisition. By bypassing the traditional phosphor scintillator and fiber optic coupling, these cameras have greatly enhanced sensitivity and detective quantum efficiency (DQE). Of the three currently available commercial cameras, the Gatan K2 Summit was designed specifically for counting individual electron events. Counting further enhances the DQE, allows for practical doubling of detector resolution and eliminates noise arising from the variable deposition of energy by each primary electron. While counting has many advantages, undercounting of electrons happens when more than one electron strikes the same area of the detector within the analog readout period (coincidence loss), which influences image quality. In this work, we characterized the K2 Summit in electron counting mode, and studied the relationship of dose rate and coincidence loss and its influence on the quality of counted images. We found that coincidence loss reduces low frequency amplitudes but has no significant influence on the signal-to-noise ratio of the recorded image. It also has little influence on high frequency signals. Images of frozen hydrated archaeal 20S proteasome (~700 kDa, D7 symmetry) recorded at the optimal dose rate retained both high-resolution signal and low-resolution contrast and enabled calculating a 3.6 Å three-dimensional reconstruction from only 10,000 particles.

  1. Influence of electron dose rate on electron counting images recorded with the K2 camera.

    PubMed

    Li, Xueming; Zheng, Shawn Q; Egami, Kiyoshi; Agard, David A; Cheng, Yifan

    2013-11-01

    A recent technological breakthrough in electron cryomicroscopy (cryoEM) is the development of direct electron detection cameras for data acquisition. By bypassing the traditional phosphor scintillator and fiber optic coupling, these cameras have greatly enhanced sensitivity and detective quantum efficiency (DQE). Of the three currently available commercial cameras, the Gatan K2 Summit was designed specifically for counting individual electron events. Counting further enhances the DQE, allows for practical doubling of detector resolution and eliminates noise arising from the variable deposition of energy by each primary electron. While counting has many advantages, undercounting of electrons happens when more than one electron strikes the same area of the detector within the analog readout period (coincidence loss), which influences image quality. In this work, we characterized the K2 Summit in electron counting mode, and studied the relationship of dose rate and coincidence loss and its influence on the quality of counted images. We found that coincidence loss reduces low frequency amplitudes but has no significant influence on the signal-to-noise ratio of the recorded image. It also has little influence on high frequency signals. Images of frozen hydrated archaeal 20S proteasome (~700 kDa, D7 symmetry) recorded at the optimal dose rate retained both high-resolution signal and low-resolution contrast and enabled calculating a 3.6 Å three-dimensional reconstruction from only 10,000 particles. PMID:23968652

  2. 78 FR 60245 - Privacy Act Systems of Records; LabWare Laboratory Information Management System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-01

    ... disease investigations and domestic control and eradication programs. Records in the system provide... APHIS staff. All access to the electronic data in the system is controlled by formal authorization. Each... that role before he or she is given access to the production system. All access to the system...

  3. 78 FR 22345 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-15

    ... contact Kimberly Scates, Information Services, National Archives and Records Administration, by April 26... Scates, Information Services, National Archives and Records Administration, 8601 Adelphi Road, College..., and service issues related to the Electronic Records Archives (ERA). This includes, but is not...

  4. 36 CFR 1235.50 - What specifications and standards for transfer apply to electronic records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... electronic records in a format that is independent of specific hardware or software. Except as specified in... indicators for variable length records, or marks delimiting a data element, field, record, or file....

  5. 36 CFR 1235.50 - What specifications and standards for transfer apply to electronic records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... electronic records in a format that is independent of specific hardware or software. Except as specified in... indicators for variable length records, or marks delimiting a data element, field, record, or file....

  6. 36 CFR 1235.50 - What specifications and standards for transfer apply to electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... electronic records in a format that is independent of specific hardware or software. Except as specified in... indicators for variable length records, or marks delimiting a data element, field, record, or file....

  7. A multimedia electronic patient record (ePR) system to improve decision support in pre- and rehabilitation through clinical and movement analysis

    NASA Astrophysics Data System (ADS)

    Liu, Brent; Documet, Jorge; McNitt-Gray, Sarah; Requejo, Phil; McNitt-Gray, Jill

    2011-03-01

    Clinical decisions for improving motor function in patients both with disability as well as improving an athlete's performance are made through clinical and movement analysis. Currently, this analysis facilitates identifying abnormalities in a patient's motor function for a large amount of neuro-musculoskeletal pathologies. However definitively identifying the underlying cause or long-term consequences of a specific abnormality in the patient's movement pattern is difficult since this requires information from multiple sources and formats across different times and currently relies on the experience and intuition of the expert clinician. In addition, this data must be persistent for longitudinal outcomes studies. Therefore a multimedia ePR system integrating imaging informatics data could have a significant impact on decision support within this clinical workflow. We present the design and architecture of such an ePR system as well as the data types that need integration in order to develop relevant decision support tools. Specifically, we will present two data model examples: 1) A performance improvement project involving volleyball athletes and 2) Wheelchair propulsion evaluation of patients with disabilities. The end result is a new frontier area of imaging informatics research within rehabilitation engineering and biomechanics.

  8. Ethical governance in biobanks linked to electronic health records.

    PubMed

    Caenazzo, L; Tozzo, P; Borovecki, A

    2015-11-01

    In the last years an alternative to traditional research projects conducted with patients has emerged: it is represented by the pairing of different type of disease biobanks specimens with Electronic Health Records (EHRs). Even if informed consent remains one of the most contested issues of biobank policy, other ethical challenges still require careful attention, given that additional issues are related to the use of EHRs. In this new way of doing research harmonization of governance is essential in practice, with the aim to make the most use of resources at our disposal, and sharing of samples and data among researchers under common policies regulating the distribution and the use. A biobank-specific Ethics Committee could be seen as a new and type of Ethics Committee, that we suggest to be applied to each biobank, with possible different functions. In particular, considering the possible use of electronic health record data linked to biological specimens in biobanking research, this specific Ethics Committee could draft best practice and ethical guidelines for the utilisation of the EHRs as a tool for genetic research, addressing concerns on accessibility, return of results and privacy and help to educate patients and healthcare providers. PMID:26592845

  9. Ethical governance in biobanks linked to electronic health records.

    PubMed

    Caenazzo, L; Tozzo, P; Borovecki, A

    2015-11-01

    In the last years an alternative to traditional research projects conducted with patients has emerged: it is represented by the pairing of different type of disease biobanks specimens with Electronic Health Records (EHRs). Even if informed consent remains one of the most contested issues of biobank policy, other ethical challenges still require careful attention, given that additional issues are related to the use of EHRs. In this new way of doing research harmonization of governance is essential in practice, with the aim to make the most use of resources at our disposal, and sharing of samples and data among researchers under common policies regulating the distribution and the use. A biobank-specific Ethics Committee could be seen as a new and type of Ethics Committee, that we suggest to be applied to each biobank, with possible different functions. In particular, considering the possible use of electronic health record data linked to biological specimens in biobanking research, this specific Ethics Committee could draft best practice and ethical guidelines for the utilisation of the EHRs as a tool for genetic research, addressing concerns on accessibility, return of results and privacy and help to educate patients and healthcare providers.

  10. Electronic Health Record-Driven Workflow for Diagnostic Radiologists.

    PubMed

    Geeslin, Matthew G; Gaskin, Cree M

    2016-01-01

    In most settings, radiologists maintain a high-throughput practice in which efficiency is crucial. The conversion from film-based to digital study interpretation and data storage launched the era of PACS-driven workflow, leading to significant gains in speed. The advent of electronic health records improved radiologists' access to patient data; however, many still find this aspect of workflow to be relatively cumbersome. Nevertheless, the ability to guide a diagnostic interpretation with clinical information, beyond that provided in the examination indication, can add significantly to the specificity of a radiologist's interpretation. Responsibilities of the radiologist include, but are not limited to, protocoling examinations, interpreting studies, chart review, peer review, writing notes, placing orders, and communicating with referring providers. Most of the aforementioned activities are not PACS-centric and require a login to one or more additional applications. Consolidation of these tasks for completion through a single interface can simplify workflow, save time, and potentially reduce the incidence of errors. Here, the authors describe diagnostic radiology workflow that leverages the electronic health record to significantly add to a radiologist's ability to be part of the health care team, provide relevant interpretations, and improve efficiency and quality. PMID:26603098

  11. Prognostics for Electronics Components of Avionics Systems

    NASA Technical Reports Server (NTRS)

    Celaya, Jose R.; Saha, Bhaskar; Wysocki, Philip F.; Goebel, Kai F.

    2009-01-01

    Electronics components have and increasingly critical role in avionics systems and for the development of future aircraft systems. Prognostics of such components is becoming a very important research filed as a result of the need to provide aircraft systems with system level health management. This paper reports on a prognostics application for electronics components of avionics systems, in particular, its application to the Isolated Gate Bipolar Transistor (IGBT). The remaining useful life prediction for the IGBT is based on the particle filter framework, leveraging data from an accelerated aging tests on IGBTs. The accelerated aging test provided thermal-electrical overstress by applying thermal cycling to the device. In-situ state monitoring, including measurements of the steady-state voltages and currents, electrical transients, and thermal transients are recorded and used as potential precursors of failure.

  12. 36 CFR 1225.24 - When can an agency apply previously approved schedules to electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... previously approved schedules to electronic records? 1225.24 Section 1225.24 Parks, Forests, and Public... can an agency apply previously approved schedules to electronic records? If the conditions specified... may apply a previously approved schedule for hard copy records to electronic versions of the...

  13. 36 CFR 1235.48 - What documentation must agencies transfer with electronic records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... agencies transfer with electronic records? 1235.48 Section 1235.48 Parks, Forests, and Public Property... agencies transfer with electronic records? (a) General. Agencies must transfer documentation adequate to identify, service, and interpret the permanent electronic records This documentation must include...

  14. 36 CFR 1235.50 - What specifications and standards for transfer apply to electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Language (SGML) or XML tags. (e) Electronic mail, scanned images of textual records, portable document... standards for transfer apply to electronic records? 1235.50 Section 1235.50 Parks, Forests, and Public... and standards for transfer apply to electronic records? (a) General. (1) Agencies must...

  15. 36 CFR 1235.48 - What documentation must agencies transfer with electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... documentation for the following types of electronic records: (i) E-mail messages with attachments; (ii) Scanned... agencies transfer with electronic records? 1235.48 Section 1235.48 Parks, Forests, and Public Property... agencies transfer with electronic records? (a) General. Agencies must transfer documentation adequate...

  16. Grasping the Nettle: The Evolution of Australian Archives Electronic Records Policy.

    ERIC Educational Resources Information Center

    O'Shea, Greg

    1997-01-01

    Examines issues in electronic records management from an archival perspective and illustrates points by referring to policy development at the Australian Archives. Describes the Australian Archives; outlines its strategy for managing electronic records; discusses policy response; preservation of format versus virtual records; and records creation,…

  17. A record system for contact tracing.

    PubMed Central

    Satin, A

    1977-01-01

    A system for recording information on patients and contacts was developed during a research project designed to measure the effectiveness of contact tracing. The record system has proved valuable in contact tracing, cross-referencing patients and their contacts, defining the characteristics of the patient and contact populations, and providing information for research and management. The value of a standardised system has been accepted by health workers who appreciate that its purpose is to increase efficiency and improve the care of infected persons. By October 1976 health workers in 16 clinics in the United Kingdom had started to use the system. PMID:576849

  18. Attitude Towards Health Information Privacy and Electronic Health Records Among Urban Sri Lankan Adults.

    PubMed

    Tissera, Shaluni R; Silva, S N

    2016-01-01

    Sri Lanka is planning to move towards an Electronic Health Record (EHR) system. This research argues that the public preparedness should be considered in order to implement a functioning and an effective EHR system in a country. When asked about how concerned the participants were about the security of their health records, 40.5% stated they were concerned and 38.8% were very concerned. They were asked to rate the 'level of trust' they have on health institutes in Sri Lanka on a scale from 1 to 10 (1 lowest level of trust and 10 highest), 66.1% rated at level 5 or less. PMID:27332453

  19. A new pulse arrival-time recording system

    SciTech Connect

    Arnone, G.J.

    1996-12-31

    We describe a new pulse arrival-time recording system that is being developed at Los Alamos. The new PATRM/PCI (Pulse Arrival-Time Recording Module/Peripheral Component Interconnect) has had several features added. These features enhance our time-correlation measurement capabilities. By applying the latest advances in electronics and computer technology we are able to increase capability over existing instrumentation while lowering the per channel cost. The modular design approach taken allows easy configuration of both small and large systems.

  20. Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users

    PubMed Central

    Pajunen, Tuuli; Saranto, Kaija; Lehtonen, Lasse

    2016-01-01

    Background The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system. Objective This study addresses two important questions: (1) “which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users?”, and (2) “which variables are associated with high- and extreme-risk severity ratings?” Methods This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach’s alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined. Results A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type “extended EHR unavailability”. The lowest overall risk level was associated with “selecting incorrectly from a list of items”. In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest (P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels (P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors. Conclusions Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should