21 CFR 11.30 - Controls for open systems.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

21 CFR 11.30 - Controls for open systems.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

21 CFR 11.30 - Controls for open systems.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

21 CFR 11.30 - Controls for open systems.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

21 CFR 11.30 - Controls for open systems.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

Implementation of a next-generation electronic nursing records system based on detailed clinical models and integration of clinical practice guidelines.

PubMed

Min, Yul Ha; Park, Hyeoun-Ae; Chung, Eunja; Lee, Hyunsook

2013-12-01

The purpose of this paper is to describe the components of a next-generation electronic nursing records system ensuring full semantic interoperability and integrating evidence into the nursing records system. A next-generation electronic nursing records system based on detailed clinical models and clinical practice guidelines was developed at Seoul National University Bundang Hospital in 2013. This system has two components, a terminology server and a nursing documentation system. The terminology server manages nursing narratives generated from entity-attribute-value triplets of detailed clinical models using a natural language generation system. The nursing documentation system provides nurses with a set of nursing narratives arranged around the recommendations extracted from clinical practice guidelines. An electronic nursing records system based on detailed clinical models and clinical practice guidelines was successfully implemented in a hospital in Korea. The next-generation electronic nursing records system can support nursing practice and nursing documentation, which in turn will improve data quality.

Implementation of an Electronic Medical Records System

DTIC Science & Technology

2008-05-07

Hartman, MAJ Roddex Barlow , CPT Christopher Besser and Capt Michael Emerson...thank you I am truly honored to call each of you my friends. Electronic... abnormal findings are addressed. 18 Electronic Medical Record Implementation Barriers of the Electronic Medical Records System There are several...examination findings • Psychological and social assessment findings N. The system provides a flexible mechanism for retrieval of encounter

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

DTIC Science & Technology

2004-12-01

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

77 FR 67203 - Privacy Act of 1974; Republication of Systems of Records Notices

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... file folders and on electronic media. RETRIEVABILITY: Accessed by name, tag number, and/or permit... DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Records are maintained on electronic media. RETRIEVABILITY... electronic media. RETRIEVABILITY: Records are accessed by individual action file number or by the name of the...

[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.

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

PubMed

Raymond, Louis; Paré, Guy; Marchand, Marie

2017-04-01

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

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

PubMed

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

2016-03-05

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

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.

3 CFR - Managing Government Records

Code of Federal Regulations, 2012 CFR

2012-01-01

... opportunities for agency records management. Greater reliance on electronic communication and systems has... improving or maintaining its records management program, particularly with respect to managing electronic... litigation; and (vi) transitioning from paper-based records management to electronic records management where...

77 FR 43100 - Privacy Act of 1974; Department of Homeland Security, Federal Emergency Management Agency-009...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-23

... Information System (NEMIS)--Mitigation (MT) Electronic Grants Management System of Records,'' and retitle it... Information System (NEMIS)--Mitigation (MT) Electronic Grants Management System of Records (69 FR 75079... Management Information System (NEMIS)--Mitigation (MT) Electronic Grants Management System (NEMIS--MT eGrants...

Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation

PubMed Central

Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

2016-01-01

Background: The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. Aim: This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. Design: A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Setting/participants: Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths (n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. Results: The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient’s preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. Conclusion: This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems. PMID:27507636

Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation.

PubMed

Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

2017-05-01

The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths ( n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient's preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems.

Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

PubMed

Decker, Sandra L; Jamoom, Eric W; Sisk, Jane E

2012-05-01

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

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

PubMed

Kossman, Susan P; Scheidenhelm, Sandra L

2008-01-01

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

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

PubMed

AlJarullah, Asma; El-Masri, Samir

2013-08-01

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

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

PubMed

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

2015-03-01

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

75 FR 64403 - Privacy Act of 1974, as Amended

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-19

... records in the system: Storage: Paper records and electronic media. Retrievability: By individual's name... information. (12) Disclose to the Office of Personnel Management the identity and status of disciplinary cases... Records in the System: Storage: Paper records and electronic media. Retrievability: By individual's name...

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

PubMed

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

2012-06-01

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

Structured electronic physiotherapy records.

PubMed

Buyl, Ronald; Nyssen, Marc

2009-07-01

With the introduction of the electronic health record, physiotherapists too are encouraged to store their patient records in a structured digital format. The typical nature of a physiotherapy treatment requires a specific record structure to be implemented, with special attention to user-friendliness and communication with other healthcare providers. The objective of this study was to establish a framework for the electronic physiotherapy record and to define a model for the interoperability with the other healthcare providers involved in the patients' care. Although we started from the Belgian context, we used a generic approach so that the results can easily be extrapolated to other countries. The framework we establish here defines not only the different building blocks of the electronic physiotherapy record, but also describes the structure and the content of the exchanged data elements. Through a combined effort by all involved parties, we elaborated an eight-level structure for the electronic physiotherapy record. Furthermore we designed a server-based model for the exchange of data between electronic record systems held by physicians and those held by physiotherapists. Two newly defined XML messages enable data interchange: the physiotherapy prescription and the physiotherapy report. We succeeded in defining a solid, structural model for electronic physiotherapist record systems. Recent wide scale implementation of operational elements such as the electronic registry has proven to make the administrative work easier for the physiotherapist. Moreover, within the proposed framework all the necessary building blocks are present for further data exchange and communication with other healthcare parties in the future. Although we completed the design of the structure and already implemented some new aspects of the electronic physiotherapy record, the real challenge lies in persuading the end-users to start using these electronic record systems. Via a quality label certification procedure, based on adequate criteria, the Ministry of Health tries to promote the use of electronic physiotherapy records. We must keep in mind that physiotherapists will show an interest in electronic record keeping, only if this will lead to a positive return for them.

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... may apply a previously approved schedule for hard copy records to electronic versions of the permanent records when the electronic records system replaces a single series of hard copy permanent records or the... have been previously scheduled as permanent in hard copy form, including special media records as...

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

PubMed

Gardner, Carrie Lee; Pearce, Patricia F

2013-03-01

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

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

PubMed

Schreiweis, Björn; Bergh, Björn

2015-01-01

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

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…

Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.

PubMed

Rangachari, Pavani

2014-12-01

Despite the federal policy momentum towards "meaningful use" of Electronic Health Records, the healthcare organizational literature remains replete with reports of unintended adverse consequences of implementing Electronic Health Records, including: increased work for clinicians, unfavorable workflow changes, and unexpected changes in communication patterns & practices. In addition to being costly and unsafe, these unintended adverse consequences may pose a formidable barrier to "meaningful use" of Electronic Health Records. Correspondingly, it is essential for hospital administrators to understand and detect the causes of unintended adverse consequences, to ensure successful implementation of Electronic Health Records. The longstanding Technology-in-Practice framework emphasizes the role of human agency in enacting structures of technology use or "technologies-in-practice." Given a set of unintended adverse consequences from health information technology implementation, this framework could help trace them back to specific actions (types of technology-in-practice) and institutional conditions (social structures). On the other hand, the more recent Knowledge-in-Practice framework helps understand how information and communication technologies ( e.g. , social knowledge networking systems) could be implemented alongside existing technology systems, to create new social structures, generate new knowledge-in-practice, and transform technology-in-practice. Therefore, integrating the two literature streams could serve the dual purpose of understanding and overcoming unintended adverse consequences of Electronic Health Record implementation. This paper seeks to: (1) review the theoretical literatures on technology use & implementation, and identify a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outline a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identify strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.

Design and implementation of an affordable, public sector electronic medical record in rural Nepal.

PubMed

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha Bangura, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2017-06-23

Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

Design and implementation of an affordable, public sector electronic medical record in rural Nepal

PubMed Central

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2018-01-01

Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty. PMID:28749321

Integrated Electronic Health Record Database Management System: A Proposal.

PubMed

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

2015-01-01

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

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

PubMed

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

2013-03-01

Electronic medical record systems are being used by more multi-national corporations. This article describes one corporation's considerations and process in successfully deploying a global electronic medical record system to international facilities in Brazil, Mexico, Singapore, and Taiwan. This article summarizes feedback from the experiences of occupational health nurse superusers in these countries. Copyright 2013, SLACK Incorporated.

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

PubMed

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

2010-10-01

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

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

PubMed Central

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

2010-01-01

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

Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model.

PubMed

Ben-Assuli, Ofir; Leshno, Moshe

2016-09-01

In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.

76 FR 51128 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... duty; alternate work schedules, standards of conduct and ethics programs; indebtedness; employee... stored on paper, microform, or in electronic media. Retrievability: By name, social security number, or... maceration. Records in electronic media are electronically erased using accepted techniques. System Manager...

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

PubMed

Ahmadi, Maryam; Ghazisaeidi, Marjan; Bashiri, Azadeh

2015-03-18

In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. This study provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with the electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. This is a cross-sectional study that was conducted in 2013. The study population was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also Visual Paradigm software was used to design a conceptual model. Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, with providing the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.

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

PubMed Central

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

2005-01-01

Abstract: The perfusion record, whether manually recorded or computer generated, is a legal representation of the procedure. The handwritten perfusion record has been the most common method of recording events that occur during cardiopulmonary bypass. This record is of significant contrast to the integrated data management systems available that provide continuous collection of data automatically or by means of a few keystrokes. Additionally, an increasing number of monitoring devices are available to assist in the management of patients on bypass. These devices are becoming more complex and provide more data for the perfusionist to monitor and record. Most of the data from these can be downloaded automatically into online data management systems, allowing more time for the perfusionist to concentrate on the patient while simultaneously producing a more accurate record. In this prospective report, we compared 17 cases that were recorded using both manual and electronic data collection techniques. The perfusionist in charge of the case recorded the perfusion using the manual technique while a second perfusionist entered relevant events on the electronic record generated by the Stockert S3 Data Management System/Data Bahn (Munich, Germany). Analysis of the two types of perfusion records showed significant variations in the recorded information. Areas that showed the most inconsistency included measurement of the perfusion pressures, flow, blood temperatures, cardioplegia delivery details, and the recording of events, with the electronic record superior in the integrity of the data. In addition, the limitations of the electronic system were also shown by the lack of electronic gas flow data in our hardware. Our results confirm the importance of accurate methods of recording of perfusion events. The use of an automated system provides the opportunity to minimize transcription error and bias. This study highlights the limitation of spot recording of perfusion events in the overall record keeping for perfusion management. PMID:16524151

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

PubMed Central

2010-01-01

Background The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically. Methods This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed. Results The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the design of knowledge-based systems, to assist the adoption process of electronic health records in an automatic fashion. From our review, six critical adoption factors have been identified: user attitude towards information systems, workflow impact, interoperability, technical support, communication among users, and expert support. The main limitation of the taxonomy is the different impact of the adoption factors of electronic health records reported by some studies depending on the type of practice, setting, or attention level; however, these features are a determinant aspect with regard to the adoption rate for the latter rather than the presence of a specific critical adoption factor. Conclusions The critical adoption factors established here provide a sound theoretical basis for research to understand, support, and facilitate the adoption of electronic health records to physicians in benefit of patients. PMID:20950458

Achieving meaningful use: a health system perspective.

PubMed

Bero, Cynthia L; Lee, Thomas H

2010-12-01

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

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.

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…

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

PubMed

Fragidis, Leonidas L; Chatzoglou, Prodromos D; Aggelidis, Vassilios P

2016-11-14

The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

Moving electronic medical records upstream: incorporating social determinants of health.

PubMed

Gottlieb, Laura M; Tirozzi, Karen J; Manchanda, Rishi; Burns, Abby R; Sandel, Megan T

2015-02-01

Knowledge of the biological pathways and mechanisms connecting social factors with health has increased exponentially over the past 25 years, yet in most clinical settings, screening and intervention around social determinants of health are not part of standard clinical care. Electronic medical records provide new opportunities for assessing and managing social needs in clinical settings, particularly those serving vulnerable populations. To illustrate the feasibility of capturing information and promoting interventions related to social determinants of health in electronic medical records. Three case studies were examined in which electronic medical records have been used to collect data and address social determinants of health in clinical settings. From these case studies, we identified multiple functions that electronic medical records can perform to facilitate the integration of social determinants of health into clinical systems, including screening, triaging, referring, tracking, and data sharing. If barriers related to incentives, training, and privacy can be overcome, electronic medical record systems can improve the integration of social determinants of health into healthcare delivery systems. More evidence is needed to evaluate the impact of such integration on health care outcomes before widespread adoption can be recommended. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

EHR/PHR Basics

MedlinePlus

... a hospital, an insurance company, or an employer. Electronic Health Records—Are They Secure? Many people wonder ... information is kept private and secure in an electronic health record system. In an electronic health record, ...

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.

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.

Procedure for Electronic Management of Rulemaking and Other Docketed Records in the Federal Docket Management System

EPA Pesticide Factsheets

This procedure identifies the specific requirements, processes and supporting documents EPA uses to electronically manage rulemaking and other docketed records in the Federal Docket Management System (FDMS).

The use of electronic health records in Spanish hospitals.

PubMed

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

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.

Safety and fitness electronic records (SAFER) system : logical architecture document : working draft

DOT National Transportation Integrated Search

1997-01-31

This Logical Architecture Document includes the products developed during the functional analysis of the Safety and Fitness Electronic Records (SAFER) System. This document, along with the companion Operational Concept and Physical Architecture Docum...

Electronic hand-drafting and picture management system.

PubMed

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

2012-08-01

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

Electronic Transfer of School Records.

ERIC Educational Resources Information Center

Yeagley, Raymond

2001-01-01

Describes the electronic transfer of student records, notably the use of a Web-server named CHARLOTTE sponsored by the National Forum on Education Statistics and an Electronic Data Exchange system named SPEEDE/ExPRESS. (PKP)

Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record.

PubMed

Grigg, Eliot; Palmer, Andrew; Grigg, Jeffrey; Oppenheimer, Peter; Wu, Tim; Roesler, Axel; Nair, Bala; Ross, Brian

2014-10-01

To evaluate the ability of an electronic system created at the University of Washington to accurately document prerecorded VF and pulseless electrical activity (PEA) cardiac arrest scenarios compared with the American Heart Association paper cardiac arrest record. 16 anaesthesiology residents were randomly assigned to view one of two prerecorded, simulated VF and PEA scenarios and asked to document the event with either the paper or electronic system. Each subject then repeated the process with the other video and documentation method. Five types of documentation errors were defined: (1) omission, (2) specification, (3) timing, (4) commission and (5) noise. The mean difference in errors between the paper and electronic methods was analysed using a single factor repeated measures ANOVA model. Compared with paper records, the electronic system omitted 6.3 fewer events (95% CI -10.1 to -2.5, p=0.003), which represents a 28% reduction in omission errors. Users recorded 2.9 fewer noise items (95% CI -5.3 to -0.6, p=0.003) when compared with paper, representing a 36% decrease in redundant or irrelevant information. The rate of timing (Δ=-3.2, 95% CI -9.3 to 3.0, p=0.286) and commission (Δ=-4.4, 95% CI -9.4 to 0.5, p=0.075) errors were similar between the electronic system and paper, while the rate of specification errors were about a third lower for the electronic system when compared with the paper record (Δ=-3.2, 95% CI -6.3 to -0.2, p=0.037). Compared with paper documentation, documentation with the electronic system captured 24% more critical information during a simulated medical emergency without loss in data quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Views of health system administrators, professionals, and users concerning the electronic health record and facilitators and obstacles to its implementation].

PubMed

Costa, Jose Felipe Riani; Portela, Margareth Crisóstomo

2018-02-05

The design and deployment of complex technologies like the electronic health record (EHR) involve technical, personal, social, and organizational issues. The Brazilian public and private scenario includes different local and regional initiatives for implementation of the electronic health record. The Brazilian Ministry of Health also has a proposal to develop a national EHR. The current study aimed to provide a comprehensive view of perceptions by health system administrators, professionals, and users concerning their experiences with the electronic health record and their opinions of the possibility of developing a national EHR. This qualitative study involved 28 semi-structured interviews. The results revealed both the diversity of factors that can influence the implementation of an electronic health record and the existence of convergences and aspects that tend to be valued differently according to the different points of view. Key aspects include discussions on the electronic health record's attributes and it impact on healthcare, especially in the case of local electronic health records, concerns over costs and confidentiality and privacy pertaining to electronic health records in general, and the possible implications of centralized versus decentralized data storage in the case of a national EHR. The interviews clearly showed the need to establish more effective communication among the various stakeholders, and that the different perspectives should be considered when drafting and deploying an EHR at the local, regional, and national levels.

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

PubMed

Krämer, T; Rapp, R; Krämer, K L

1999-03-01

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

From planning to realisation of an electronic patient record.

PubMed

Krämer, T; Rapp, R; Krämer, K-L

1999-03-01

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

75 FR 57333 - Privacy Act of 1974; Republication of Systems of Records Notices

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... file folders and on electronic media. RETRIEVABILITY: Accessed by name, tag number, and/or permit... file folders and on electronic media. RETRIEVABILITY: Records are accessed by name. SAFEGUARDS: Records... SYSTEM: 5 CFR 2634-2641, 5801; 5 U.S.C. 7351, 7353; Ethics in Government Act of 1978, as amended (5 U.S.C...

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

ERIC Educational Resources Information Center

Slaughter, Andre

2017-01-01

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

21 CFR 11.10 - Controls for closed systems.

Code of Federal Regulations, 2014 CFR

2014-04-01

... controls designed to ensure the authenticity, integrity, and, when appropriate, the confidentiality of... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Controls for closed systems. 11.10 Section 11.10... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.10 Controls for closed systems. Persons who use...

21 CFR 11.10 - Controls for closed systems.

Code of Federal Regulations, 2010 CFR

2010-04-01

... controls designed to ensure the authenticity, integrity, and, when appropriate, the confidentiality of... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Controls for closed systems. 11.10 Section 11.10... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.10 Controls for closed systems. Persons who use...

21 CFR 11.10 - Controls for closed systems.

Code of Federal Regulations, 2013 CFR

2013-04-01

... controls designed to ensure the authenticity, integrity, and, when appropriate, the confidentiality of... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Controls for closed systems. 11.10 Section 11.10... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.10 Controls for closed systems. Persons who use...

21 CFR 11.10 - Controls for closed systems.

Code of Federal Regulations, 2011 CFR

2011-04-01

... controls designed to ensure the authenticity, integrity, and, when appropriate, the confidentiality of... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Controls for closed systems. 11.10 Section 11.10... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.10 Controls for closed systems. Persons who use...

21 CFR 11.10 - Controls for closed systems.

Code of Federal Regulations, 2012 CFR

2012-04-01

... controls designed to ensure the authenticity, integrity, and, when appropriate, the confidentiality of... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Controls for closed systems. 11.10 Section 11.10... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.10 Controls for closed systems. Persons who use...

75 FR 41487 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

...: Electronic Health Records Demonstration System (EHRDS)--practice application and profile update system; Use... reward the delivery of high-quality care supported by the adoption and use of electronic health records... demonstration system was first developed with the intention of having practices applying to participate in Phase...

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

PubMed

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

2017-01-01

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

12 CFR 609.945 - Records retention.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Records retention. 609.945 Section 609.945 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Standards for Boards and Management § 609.945 Records retention. Records stored electronically must be accurate, accessible...

36 CFR § 1222.26 - What are the general recordkeeping requirements for agency programs?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF... be created and maintained to document program policies, procedures, functions, activities, and... electronic records; (c) Related records series and systems; (d) The relationship between paper and electronic...

12 CFR 609.945 - Records retention.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Records retention. 609.945 Section 609.945 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Standards for Boards and Management § 609.945 Records retention. Records stored electronically must be accurate, accessible...

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…

10 CFR 61.80 - Maintenance of records, reports, and transfers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... receipt and disposal of radioactive waste in an electronic recordkeeping system. (1) The manifest... RADIOACTIVE WASTE Records, Reports, Tests, and Inspections § 61.80 Maintenance of records, reports, and.... The record may also be stored in electronic media with the capability for producing legible, accurate...

77 FR 65913 - Privacy Act of 1974: Systems of Records.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-31

... performing clerical, stenographic, or data analysis functions, or by reproduction of records by electronic or... performing clerical, stenographic, or data analysis functions, or by reproduction of records by electronic or... Services (OGIS) National Archives and Records Administration, in connection with mediation of FOIA requests...

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…

[Results of training in the electronic health records in a tertiary care hospital].

PubMed

Alva Espinosa, Carlos; Fuentes Domínguez, Marco Antonio; Garibay Huarte, Tania

2014-12-01

To assess the user evaluation of the electronic health records system together with its training program and to investigate the relation between the number of training sessions and the corresponding evaluation scores given by the participants. An anonymous survey was conducted between the medical, nursing and social worker personnel. The survey included seven multiple-choice questions with a numerical scale from 1 to 10 and an additional open question. IBM SPSS Statistics v18 software was used to perform ANOVA variance analysis. In total, 340 workers participated in this study; 317 were included in the statistical analysis, out of which 76% had one or two training sessions, 13.9% received three or more sessions and 10% had no training. The mean global training evaluation by the participants was 5.9 ± 2.3, median 6.3, while the electronic records system evaluation was 5.2 ± 2.3, median 5.5. In relation to the training and electronic records system it was observed that higher evaluation scores were obtained with increasing number of training sessions (p < 0.001). On the electronic records systems, personnel with no training evaluated the system with a mean score of 3.9 ± 2.7, while those who received three or more training sessions evaluated the system with a mean score of 6.1 ± 1.8 (p < 0.001).

Implementation of standardized nomenclature in the electronic medical record.

PubMed

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

2009-01-01

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

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…

Ten tips for successful electronic health records deployment.

PubMed

Gasch, Art

2012-01-01

As healthcare providers are increasingly compelled to adopt electronic health records (EHRs) and paper records migrate to electronic files provided to dozens of healthcare intermediaries, breeches of protected health information are skyrocketing, and so are dissatisfaction rates with EHR solutions. This article provides 10 practical tips to ensure a successful EHR system deployment an circumvent EHR land mines.

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…

14 CFR 221.300 - Discontinuation of electronic tariff system.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 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 to...

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 to...

14 CFR 221.300 - Discontinuation of electronic tariff system.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 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 to...

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 to...

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

PubMed

Wilhoit, Kathryn; Mustain, Jane; King, Marjorie

2006-01-01

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

A First Standardized Swiss Electronic Maternity Record.

PubMed

Murbach, Michel; Martin, Sabine; Denecke, Kerstin; Nüssli, Stephan

2017-01-01

During the nine months of pregnancy, women have to regularly visit several physicians for continuous monitoring of the health and development of the fetus and mother. Comprehensive examination results of different types are generated in this process; documentation and data transmission standards are still unavailable or not in use. Relevant information is collected in a paper-based maternity record carried by the pregnant women. To improve availability and transmission of data, we aim at developing a first prototype for an electronic maternity record for Switzerland. By analyzing the documentation workflow during pregnancy, we determined a maternity record data set. Further, we collected requirements towards a digital maternity record. As data exchange format, the Swiss specific exchange format SMEEX (swiss medical data exchange) was exploited. Feedback from 27 potential users was collected to identify further improvements. The relevant data is extracted from the primary care information system as SMEEX file, stored in a database and made available in a web and a mobile application, developed as prototypes of an electronic maternity record. The user confirmed the usefulness of the system and provided multiple suggestions for an extension. An electronical maternity record as developed in this work could be in future linked to the electronic patient record.

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

PubMed

Springman, Scott R

2011-09-01

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

75 FR 76997 - Agency Information Collection Activities: Arrival and Departure Record (Forms I-94 and I-94W) and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-10

... Activities: Arrival and Departure Record (Forms I-94 and I-94W) and Electronic System for Travel... I-94W (Nonimmigrant Visa Waiver Arrival/Departure), and the Electronic System for Travel... points: [[Page 76998

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

PubMed

Bouamrane, Matt-Mouley; Mair, Frances S

2013-05-21

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

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

PubMed Central

2013-01-01

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

Electronic health records to facilitate clinical research.

PubMed

Cowie, Martin R; Blomster, Juuso I; Curtis, Lesley H; Duclaux, Sylvie; Ford, Ian; Fritz, Fleur; Goldman, Samantha; Janmohamed, Salim; Kreuzer, Jörg; Leenay, Mark; Michel, Alexander; Ong, Seleen; Pell, Jill P; Southworth, Mary Ross; Stough, Wendy Gattis; Thoenes, Martin; Zannad, Faiez; Zalewski, Andrew

2017-01-01

Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research.

49 CFR 228.201 - Electronic recordkeeping; general.

Code of Federal Regulations, 2014 CFR

2014-10-01

... transmission, storage, and retrieval provided that all of the following conditions are met: (1) The system used... generated record contains the information required by § 228.11; (3) The railroad, or contractor or... electronic recordkeeping system to enter the information necessary to create their hours of service record...

49 CFR 228.201 - Electronic recordkeeping; general.

Code of Federal Regulations, 2012 CFR

2012-10-01

... transmission, storage, and retrieval provided that all of the following conditions are met: (1) The system used... generated record contains the information required by § 228.11; (3) The railroad, or contractor or... electronic recordkeeping system to enter the information necessary to create their hours of service record...

49 CFR 228.201 - Electronic recordkeeping; general.

Code of Federal Regulations, 2013 CFR

2013-10-01

... transmission, storage, and retrieval provided that all of the following conditions are met: (1) The system used... generated record contains the information required by § 228.11; (3) The railroad, or contractor or... electronic recordkeeping system to enter the information necessary to create their hours of service record...

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. © The Author(s) 2015.

New paradigms for measuring clinical performance using electronic health records.

PubMed

Weiner, Jonathan P; Fowles, Jinnet B; Chan, Kitty S

2012-06-01

Measures of provider success are the centerpiece of quality improvement and pay-for-performance programs around the globe. In most nations, these measures are derived from administrative records, paper charts and consumer surveys; increasingly, electronic patient record systems are also being used. We use the term 'e-QMs' to describe quality measures that are based on data found within electronic health records and other related health information technology (HIT). We offer a framework or typology for e-QMs and describe opportunities and impediments associated with the transition from old to new If public and private systems of care are to effectively use HIT to support and evaluate health-care system quality and safety, the quality measurement field must embrace new paradigms and strategically address a series of technical, conceptual and practical challenges.

Quality of nursing documentation: Paper-based health records versus electronic-based health records.

PubMed

Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam

2018-02-01

To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes. © 2017 John Wiley & Sons Ltd.

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

PubMed Central

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

2017-01-01

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

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

PubMed

Wojcik, Lauren

2015-01-01

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

36 CFR 1236.12 - What other records management and preservation considerations must be incorporated into the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management and Preservation Considerations for Designing and Implementing Electronic Information Systems... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What other records management... of electronic information systems? 1236.12 Section 1236.12 Parks, Forests, and Public Property...

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 research…

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…

75 FR 77851 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-14

... proposed action will be effective without further notice on January 13, 2011 unless comments are received... system: Records may contain an individual's name, Social Security Number (SSN) within supporting..., retaining, and disposing of records in the system: Storage: Paper records and electronic storage media...

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

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

PubMed

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

2002-01-01

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

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

PubMed

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

2015-07-01

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

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.

77 FR 23543 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

...As required by the Privacy Act of 1974 (5 U.S.C. 552a(e)(4), (11)), notice is hereby given that the Department of Veterans Affairs (VA) is amending the system of records entitled ``Veterans Tracking Application (VTA).'' VA is amending the system of records by revising the System Name to ``Veterans Tracking Application (VTA)/Federal Case Management Tool (FCMT)'' and System Location to include the ``Federal Case Management Tool (FCMT).'' The VTA data will also be accessed using the FCMT. Further, the Routine Uses have been updated in conjunction with VA's Virtual Lifetime Electronic Record (VLER), to reflect the nature of electronic coordination that will fully support the users of this application. VA is republishing the system notice in its entirety.

Legal issues of the electronic dental record: security and confidentiality.

PubMed

Szekely, D G; Milam, S; Khademi, J A

1996-01-01

Computer-based, electronic dental record keeping involves complex issues of patient privacy and the dental practitioner's ethical duty of confidentiality. Federal and state law is responding to the new legal issues presented by computer technology. Authenticating the electronic record in terms of ensuring its reliability and accuracy is essential in order to protect its admissibility as evidence in legal actions. Security systems must be carefully planned to limit access and provide for back-up and storage of dental records. Carefully planned security systems protect the patient from disclosure without the patient's consent and also protect the practitioner from the liability that would arise from such disclosure. Human errors account for the majority of data security problems. Personnel security is assured through pre-employment screening, employment contracts, policies, and staff education. Contracts for health information systems should include provisions for indemnification and ensure the confidentiality of the system by the vendor.

The electronic medical record in dermatology.

PubMed

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

2010-09-01

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

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…

"Teaching Case": ComprehensiveCare and the Stalled Adoption of an Electronic Health Records System: IT Governance and Employee Succession

ERIC Educational Resources Information Center

Gomillion, David L.

2017-01-01

ComprehensiveCare, a multi-specialty healthcare organization, struggles to implement Electronic Health Records. The first adoption failed outright because the customizations made the system unusable. The second attempted adoption has not officially failed yet, but the system fails to live up to the expectations. It lingers on the edge of…

Understanding Providers' Interaction with Graphical User Interface Pertaining to Clinical Document Usage in an Electronic Health Record System

ERIC Educational Resources Information Center

Rizvi, Rubina Fatima

2017-01-01

Despite high Electronic Health Record (EHR) system adoption rates by hospital and office-based practices, many users remain highly dissatisfied with the current state of EHRs. Sub-optimal EHR usability as a result of insufficient incorporation of User-Centered Design (UCD) approach during System Development Life Cycle process (SDLC) is considered…

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…

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…

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…

Critical issues in an electronic documentation system.

PubMed

Weir, Charlene R; Nebeker, Jonathan R

2007-10-11

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

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.

78 FR 19247 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-29

... Privacy Act system of records. SUMMARY: In accordance with the requirements of the Privacy Act of 1974, as... subject to the Privacy Act of 1974. This system of records maintains information on patent applicants and... notices. The storage and safeguard information has been updated to include electronic records. The...

[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.

Large-scale recording of thalamocortical circuits: in vivo electrophysiology with the two-dimensional electronic depth control silicon probe

PubMed Central

Fiáth, Richárd; Beregszászi, Patrícia; Horváth, Domonkos; Wittner, Lucia; Aarts, Arno A. A.; Ruther, Patrick; Neves, Hercules P.; Bokor, Hajnalka; Acsády, László

2016-01-01

Recording simultaneous activity of a large number of neurons in distributed neuronal networks is crucial to understand higher order brain functions. We demonstrate the in vivo performance of a recently developed electrophysiological recording system comprising a two-dimensional, multi-shank, high-density silicon probe with integrated complementary metal-oxide semiconductor electronics. The system implements the concept of electronic depth control (EDC), which enables the electronic selection of a limited number of recording sites on each of the probe shafts. This innovative feature of the system permits simultaneous recording of local field potentials (LFP) and single- and multiple-unit activity (SUA and MUA, respectively) from multiple brain sites with high quality and without the actual physical movement of the probe. To evaluate the in vivo recording capabilities of the EDC probe, we recorded LFP, MUA, and SUA in acute experiments from cortical and thalamic brain areas of anesthetized rats and mice. The advantages of large-scale recording with the EDC probe are illustrated by investigating the spatiotemporal dynamics of pharmacologically induced thalamocortical slow-wave activity in rats and by the two-dimensional tonotopic mapping of the auditory thalamus. In mice, spatial distribution of thalamic responses to optogenetic stimulation of the neocortex was examined. Utilizing the benefits of the EDC system may result in a higher yield of useful data from a single experiment compared with traditional passive multielectrode arrays, and thus in the reduction of animals needed for a research study. PMID:27535370

Development of clinical contents model markup language for electronic health records.

PubMed

Yun, Ji-Hyun; Ahn, Sun-Ju; Kim, Yoon

2012-09-01

To develop dedicated markup language for clinical contents models (CCM) to facilitate the active use of CCM in electronic health record systems. Based on analysis of the structure and characteristics of CCM in the clinical domain, we designed extensible markup language (XML) based CCM markup language (CCML) schema manually. CCML faithfully reflects CCM in both the syntactic and semantic aspects. As this language is based on XML, it can be expressed and processed in computer systems and can be used in a technology-neutral way. CCML HAS THE FOLLOWING STRENGTHS: it is machine-readable and highly human-readable, it does not require a dedicated parser, and it can be applied for existing electronic health record systems.

49 CFR 237.155 - Documents and records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the information required by this part; (3) The track owner monitors its electronic records database...; (4) The track owner shall train its employees who use the system on the proper use of the electronic...

"Teaching Case": ComprehensiveCare and the Failed Implementation of an Electronic Health Records System

ERIC Educational Resources Information Center

Gomillion, David L.

2017-01-01

Administrator Jennifer Stanton attempts to adopt an Electronic Health Records system at ComprehensiveCare, a multispecialty healthcare practice. Consultants from the vendor provide guidance to the organization, but do not provide that guidance in a way that the non-technical administrator understands. The project experiences escalation of…

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…

Electronic Health Record System Contingency Plan Coordination: A Strategy for Continuity of Care Considering Users' Needs.

PubMed

Fernández, Marcela T; Gómez, Adrián R; Santojanni, Américo M; Cancio, Alfredo H; Luna, Daniel R; Benítez, Sonia E

2015-01-01

Electronic Health Record system downtimes may have a great impact on patient care continuity. This paper describes the analysis and actions taken to redesign the Contingency Plan Procedure for the Electronic Health Record System of Hospital Italiano de Buenos Aires. After conducting a thorough analysis of the data gathered at post-contingency meetings, weaknesses were identified in the procedure; thus, strategic actions were recommended to redesign the Contingency Plan to secure an effective communications channel, as well as a formal structure for functions that may support the decision-making process. The main actions were: 1) to incorporate the IT Contingencies Committee (Plan management); 2) to incorporate the Coordinator (general supervision of the procedure); and 3) to redefine the role of the Clinical Informatics Resident, who will be responsible for managing communication between the technical team and Electronic Health Record users. As users need the information for continuity of care, key users evaluated the impact of the new strategy with an adapted survey.

Electronic Health Object

PubMed Central

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

2015-01-01

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

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

PubMed

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

2017-11-01

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

76 FR 49753 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-11

... Defense. DHA 14 System name: Computer/Electronics Accommodations Program for People with Disabilities... with ``Computer/Electronic Accommodations Program.'' System location: Delete entry and replace with ``Computer/Electronic Accommodations Program, Skyline 5, Suite 302, 5111 Leesburg Pike, Falls Church, VA...

78 FR 41962 - Privacy Act of 1974: Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

..., or data analysis functions, or by reproduction of records by electronic or other means. Recipients of... Information Act (FOIA), and to facilitate OGIS' offering of mediation services to resolve disputes between... performing clerical, stenographic, or data analysis functions, or by reproduction of records by electronic or...

78 FR 63196 - Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

... Technology Center (ITC) staff and contractors, who maintain the FCC's computer network. Other FCC employees... and Offices (B/ Os); 2. Electronic data, records, and files that are stored in the FCC's computer.... Access to the FACA electronic records, files, and data, which are housed in the FCC's computer network...

A system for multichannel recording and automatic reading of information. [for onboard cosmic ray counter

NASA Technical Reports Server (NTRS)

Bogomolov, E. A.; Yevstafev, Y. Y.; Karakadko, V. K.; Lubyanaya, N. D.; Romanov, V. A.; Totubalina, M. G.; Yamshchikov, M. A.

1975-01-01

A system for the recording and processing of telescope data is considered for measurements of EW asymmetry. The information is recorded by 45 channels on a continuously moving 35-mm film. The dead time of the recorder is about 0.1 sec. A sorting electronic circuit is used to reduce the errors when the statistical time distribution of the pulses is recorded. The recorded information is read out by means of photoresistors. The phototransmitter signals are fed either to the mechanical recorder unit for preliminary processing, or to a logical circuit which controls the operation of the punching device. The punched tape is processed by an electronic computer.

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

PubMed

Cunningham, James; Ainsworth, John

2017-01-01

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

76 FR 35859 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... deleting and shredding paper copies. Registers are destroyed by electronic deletion 40 years after the date... electronically deleting and shredding paper copies. Registers are destroyed by electronic deletion 40 years after...) is used to authenticate and lock out unauthorized access. Paper records are maintained in locked file...

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

PubMed

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

2003-01-01

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

Electronic medical records for otolaryngology office-based practice.

PubMed

Chernobilsky, Boris; Boruk, Marina

2008-02-01

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

Benefits of Implementing and Improving Collection of Sexual Orientation and Gender Identity Data in Electronic Health Records.

PubMed

Bosse, Jordon D; Leblanc, Raeann G; Jackman, Kasey; Bjarnadottir, Ragnhildur I

2018-06-01

Individuals in lesbian, gay, bisexual, and transgender communities experience several disparities in physical and mental health (eg, cardiovascular disease and depression), as well as difficulty accessing care that is compassionate and relevant to their unique needs. Access to care is compromised in part due to inadequate information systems that fail to capture identity data. Beginning in January 2018, meaningful use criteria dictate that electronic health records have the capability to collect data related to sexual orientation and gender identity of patients. Nurse informaticists play a vital role in the process of developing new electronic health records that are sensitive to the needs and identities of the lesbian, gay, bisexual, and transgender communities. Improved collection of sexual orientation and gender identity data will advance the identification of health disparities experienced by lesbian, gay, bisexual, and transgender populations. More inclusive electronic health records will allow providers to monitor risk behavior, assess progress toward the reduction of disparities, and provide healthcare that is patient and family centered. Concrete suggestions for the modification of electronic health record systems are presented, as well as how nurse informaticists may be able to bridge gaps in provider knowledge and discomfort through interprofessional collaboration when implementing changes in electronic health records.

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

PubMed

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

2013-06-01

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

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

ERIC Educational Resources Information Center

Wlodyga, Linda J.

2010-01-01

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

Accuracy of parent-reported measles-containing vaccination status of children with measles.

PubMed

Liu, G; Liao, Z; Xu, X; Liang, Y; Xiong, Y; Ni, J

2017-03-01

The validity of parent-reported measles-containing vaccination history in children with measles has not been assessed. This study evaluated the accuracy of parental recall of measles-containing vaccination histories in Shenzhen, China. A retrospective study was performed to compare the data from the electronic records with parental recall. The electronic records were regarded as accurate data about the children's measles-containing vaccination status. We collected data from the National Notifiable Diseases Surveillance System and the Immunization Program Information Management System in Shenzhen city, China. Between 2009 and 2014, there were 163 children with measles who had electronic vaccination records; the vaccination status of these cases was reported by the parents in the field epidemiological investigation. We validated parental recall with electronic records. The agreement between parental recall and electronic records was 78.7%. The kappa value was 0.57. The parent-reported measles-containing vaccination rate was higher than the electronic record (48.5% vs 41.7%, χ 2  = 53.64, P < 0.001). The true positive rate for parental recall was 82.4%, and the true negative rate was 75.8%. The positive predictive value was 70.9%, and the negative predictive value was 76.6%. In children with measles, parental recall slightly overestimated the measles vaccination rate, and the vaccination status recalled by parents was in moderate agreement with the electronic record. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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

PubMed

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

2001-01-01

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

Health-oriented electronic oral health record: development and evaluation.

PubMed

Wongsapai, Mansuang; Suebnukarn, Siriwan; Rajchagool, Sunsanee; Beach, Daryl; Kawaguchi, Sachiko

2014-06-01

This study aims to develop and evaluate a new Health-oriented Electronic Oral Health Record that implements the health-oriented status and intervention index. The index takes the principles of holistic oral healthcare and applies them to the design and implementation of the Health-oriented Electronic Oral Health Record. We designed an experiment using focus groups and a consensus (Delphi process) method to develop a new health-oriented status and intervention index and graphical user interface. A comparative intervention study with qualitative and quantitative methods was used to compare an existing Electronic Oral Health Record to the Health-oriented Electronic Oral Health Record, focusing on dentist satisfaction, accuracy, and completeness of oral health status recording. The study was conducted by the dental staff of the Inter-country Center for Oral Health collaborative hospitals in Thailand. Overall, the user satisfaction questionnaire had a positive response to the Health-oriented Electronic Oral Health Record. The dentists found it easy to use and were generally satisfied with the impact on their work, oral health services, and surveillance. The dentists were significantly satisfied with the Health-oriented Electronic Oral Health Record compared to the existing Electronic Oral Health Record (p < 0.001). The accuracy and completeness values of the oral health information recorded using the Health-oriented Electronic Oral Health Record were 97.15 and 93.74 percent, respectively. This research concludes that the Health-oriented Electronic Oral Health Record satisfied many dentists, provided benefits to holistic oral healthcare, and facilitated the planning, managing, and evaluation of the healthcare delivery system.

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

PubMed

Agno, Christina Farala; Guo, Kristina L

2013-01-01

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

78 FR 8536 - Privacy Act of 1974; Report of New System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... operating system. Any electronic or hard copies of financial- related records containing PII at CMS and... SYSTEM: None. Dated: January 10, 2013. Michelle Snyder, Deputy Chief Operating Officer, Centers for... 1974; Report of New System of Records AGENCY: Department of Health and Human Services (HHS), Centers...

[Access control management in electronic health records: a systematic literature review].

PubMed

Carrión Señor, Inmaculada; Fernández Alemán, José Luis; Toval, Ambrosio

2012-01-01

This study presents the results of a systematic literature review of aspects related to access control in electronic health records systems, wireless security and privacy and security training for users. Information sources consisted of original articles found in Medline, ACM Digital Library, Wiley InterScience, IEEE Digital Library, Science@Direct, MetaPress, ERIC, CINAHL and Trip Database, published between January 2006 and January 2011. A total of 1,208 articles were extracted using a predefined search string and were reviewed by the authors. The final selection consisted of 24 articles. Of the selected articles, 21 dealt with access policies in electronic health records systems. Eleven articles discussed whether access to electronic health records should be granted by patients or by health organizations. Wireless environments were only considered in three articles. Finally, only four articles explicitly mentioned that technical training of staff and/or patients is required. Role-based access control is the preferred mechanism to deploy access policy by the designers of electronic health records. In most systems, access control is managed by users and health professionals, which promotes patients' right to control personal information. Finally, the security of wireless environments is not usually considered. However, one line of research is eHealth in mobile environments, called mHealth. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

The record of electrical and communication engineering conversazione Tohoku University Volume 63, No. 3

NASA Astrophysics Data System (ADS)

1995-05-01

English abstracts contained are from papers authored by the research staff of the Research Institute of Electrical Communication and the departments of Electrical Engineering, Electrical Communications, Electronic Engineering, and Information Engineering, Tohoku University, which originally appeared in scientific journals in 1994. The abstracts are organized under the following disciplines: electromagnetic theory; physics; fundamental theory of information; communication theory and systems; signal and image processing; systems control; computers; artificial intelligence; recording; acoustics and speech; ultrasonic electronics; antenna, propagation, and transmission; optoelectronics and optical communications; quantum electronics; superconducting materials and applications; magnetic materials and magnetics; semiconductors; electronic materials and parts; electronic devices and integrated circuits; electronic circuits; medical electronics and bionics; measurements and applied electronics; electric power; and miscellaneous.

Evaluation of immunization data completeness within a large community health care system exchanging data with a state immunization information system.

PubMed

Hendrickson, Bryan K; Panchanathan, Sarada S; Petitti, Diana

2015-01-01

Information systems are used by most states to maintain registries of immunization data both for monitoring population-level adherence and for use in clinical practice and research. Direct data exchange between such systems and electronic health record systems presents an opportunity to improve the completeness and quality of information available. Our goals were to describe and compare the completeness of the Arizona State Immunization System, the electronic health record at a large community health provider in Arizona exchanging electronic data with the Arizona system, and personal immunization records in an effort to contribute to the discussion on the completeness of state-run immunization registries and data exchange with these registries. Immunization histories from these sources were collected and reviewed sequentially. Unique dates of vaccination administrations were counted for each patient and tagged on the basis of comparisons across sources. We quantified completeness by combining information from all 3 sources and comparing each source with the complete set. We determined that the state registry was 71.8% complete, the hospital electronic health record was 81.9% complete, and personal records were 87.8% complete. Of the 2017 unique vaccination administrations, 65% were present in all 3 sources, 24.6% in 2 of the 3 sources, and 10.4% in only 1 source. Only 11% of patients had records in complete agreement across the 3 sources. This study highlights issues related to data completeness, exchange, and reporting of immunization information to state registries and suggests that there is some degree of deficiency in completeness of immunization registries and other sources. This study indicates that there is a need to strengthen links between electronic data sources with immunization information and describes potential improvements in completeness that such efforts could provide, enabling providers to better rely on state immunization registries and to improve research utilization of immunization information systems.

Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation.

PubMed

Sefton, Gerri; Lane, Steven; Killen, Roger; Black, Stuart; Lyon, Max; Ampah, Pearl; Sproule, Cathryn; Loren-Gosling, Dominic; Richards, Caitlin; Spinty, Jean; Holloway, Colette; Davies, Coral; Wilson, April; Chean, Chung Shen; Carter, Bernie; Carrol, E D

2017-05-01

Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.

Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.

PubMed

Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas

2014-09-01

To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its enabling factors has the potential to support efforts at implementing national electronic health record implementation endeavors. © The Author(s) 2013.

75 FR 13094 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-18

... effective on April 19, 2010 unless comments are received that would result in a contrary determination... Reserve Component personnel. Categories of records in the system: Name, Social Security Number (SSN..., accessing, retaining, and disposing of records in the system: Storage: Electronic storage media...

76 FR 44349 - Agency Information Collection Activities: Arrival and Departure Record (Forms I-94 and I-94W) and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-25

... Activities: Arrival and Departure Record (Forms I-94 and I-94W) and Electronic System for Travel... I-94W (Nonimmigrant Visa Waiver Arrival/Departure), and the Electronic System for Travel... points: (1) Evaluate whether the proposed collection of information is necessary for the proper...

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…

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

ERIC Educational Resources Information Center

Bazile, Emmanuel Patrick

2016-01-01

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

Development of Clinical Contents Model Markup Language for Electronic Health Records

PubMed Central

Yun, Ji-Hyun; Kim, Yoon

2012-01-01

Objectives To develop dedicated markup language for clinical contents models (CCM) to facilitate the active use of CCM in electronic health record systems. Methods Based on analysis of the structure and characteristics of CCM in the clinical domain, we designed extensible markup language (XML) based CCM markup language (CCML) schema manually. Results CCML faithfully reflects CCM in both the syntactic and semantic aspects. As this language is based on XML, it can be expressed and processed in computer systems and can be used in a technology-neutral way. Conclusions CCML has the following strengths: it is machine-readable and highly human-readable, it does not require a dedicated parser, and it can be applied for existing electronic health record systems. PMID:23115739

76 FR 5973 - Privacy Act of 1974; Notice; Publication of the Systems of Records Managed by the Commodity...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

...: Paper records are stored in file folders, binders, computer files (eLaw) and computer disks. Electronic records, including computer files, are stored on the Commission's network and other electronic media as... physical security measures. Technical security measures within CFTC include restrictions on computer access...

Application of a large electronic health record database to study effects of air quality on mortality in a heart failure population

EPA Science Inventory

Background: Electronic health records (EHRs) are now a ubiquitous component of the US healthcare system and are attractive for secondary data analysis as they contain detailed and longitudinal clinical records on potentially millions of individuals. However, due to their relative...

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…

36 CFR 1236.12 - What other records management and preservation considerations must be incorporated into the...

Code of Federal Regulations, 2011 CFR

2011-07-01

... exchange of electronic documents between offices using different software or operating systems. ... of electronic information systems? 1236.12 Section 1236.12 Parks, Forests, and Public Property... Management and Preservation Considerations for Designing and Implementing Electronic Information Systems...

36 CFR 1236.12 - What other records management and preservation considerations must be incorporated into the...

Code of Federal Regulations, 2012 CFR

2012-07-01

... exchange of electronic documents between offices using different software or operating systems. ... of electronic information systems? 1236.12 Section 1236.12 Parks, Forests, and Public Property... Management and Preservation Considerations for Designing and Implementing Electronic Information Systems...

36 CFR 1236.12 - What other records management and preservation considerations must be incorporated into the...

Code of Federal Regulations, 2014 CFR

2014-07-01

... exchange of electronic documents between offices using different software or operating systems. ... of electronic information systems? 1236.12 Section 1236.12 Parks, Forests, and Public Property... Management and Preservation Considerations for Designing and Implementing Electronic Information Systems...

Balancing Good Intentions: Protecting the Privacy of Electronic Health Information

ERIC Educational Resources Information Center

McClanahan, Kitty

2008-01-01

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

Large-scale recording of thalamocortical circuits: in vivo electrophysiology with the two-dimensional electronic depth control silicon probe.

PubMed

Fiáth, Richárd; Beregszászi, Patrícia; Horváth, Domonkos; Wittner, Lucia; Aarts, Arno A A; Ruther, Patrick; Neves, Hercules P; Bokor, Hajnalka; Acsády, László; Ulbert, István

2016-11-01

Recording simultaneous activity of a large number of neurons in distributed neuronal networks is crucial to understand higher order brain functions. We demonstrate the in vivo performance of a recently developed electrophysiological recording system comprising a two-dimensional, multi-shank, high-density silicon probe with integrated complementary metal-oxide semiconductor electronics. The system implements the concept of electronic depth control (EDC), which enables the electronic selection of a limited number of recording sites on each of the probe shafts. This innovative feature of the system permits simultaneous recording of local field potentials (LFP) and single- and multiple-unit activity (SUA and MUA, respectively) from multiple brain sites with high quality and without the actual physical movement of the probe. To evaluate the in vivo recording capabilities of the EDC probe, we recorded LFP, MUA, and SUA in acute experiments from cortical and thalamic brain areas of anesthetized rats and mice. The advantages of large-scale recording with the EDC probe are illustrated by investigating the spatiotemporal dynamics of pharmacologically induced thalamocortical slow-wave activity in rats and by the two-dimensional tonotopic mapping of the auditory thalamus. In mice, spatial distribution of thalamic responses to optogenetic stimulation of the neocortex was examined. Utilizing the benefits of the EDC system may result in a higher yield of useful data from a single experiment compared with traditional passive multielectrode arrays, and thus in the reduction of animals needed for a research study. Copyright © 2016 the American Physiological Society.

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

PubMed

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

2012-03-01

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

78 FR 26623 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-07

...: Mr. Leroy Jones, Department of the Army, Privacy Office, U.S. Army Records Management and... disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, these records..., accessing, retaining, and disposing of records in the system: Storage: Paper records and electronic storage...

Integration of Evidence into a Detailed Clinical Model-based Electronic Nursing Record System

PubMed Central

Park, Hyeoun-Ae; Jeon, Eunjoo; Chung, Eunja

2012-01-01

Objectives The purpose of this study was to test the feasibility of an electronic nursing record system for perinatal care that is based on detailed clinical models and clinical practice guidelines in perinatal care. Methods This study was carried out in five phases: 1) generating nursing statements using detailed clinical models; 2) identifying the relevant evidence; 3) linking nursing statements with the evidence; 4) developing a prototype electronic nursing record system based on detailed clinical models and clinical practice guidelines; and 5) evaluating the prototype system. Results We first generated 799 nursing statements describing nursing assessments, diagnoses, interventions, and outcomes using entities, attributes, and value sets of detailed clinical models for perinatal care which we developed in a previous study. We then extracted 506 recommendations from nine clinical practice guidelines and created sets of nursing statements to be used for nursing documentation by grouping nursing statements according to these recommendations. Finally, we developed and evaluated a prototype electronic nursing record system that can provide nurses with recommendations for nursing practice and sets of nursing statements based on the recommendations for guiding nursing documentation. Conclusions The prototype system was found to be sufficiently complete, relevant, useful, and applicable in terms of content, and easy to use and useful in terms of system user interface. This study has revealed the feasibility of developing such an ENR system. PMID:22844649

Activation of a medical emergency team using an electronic medical recording-based screening system*.

PubMed

Huh, Jin Won; Lim, Chae-Man; Koh, Younsuck; Lee, Jury; Jung, Youn-Kyung; Seo, Hyun-Suk; Hong, Sang-Bum

2014-04-01

To evaluate the efficacy of a medical emergency team activated using 24-hour monitoring by electronic medical record-based screening criteria followed by immediate intervention by a skilled team. Retrospective cohort study. Academic tertiary care hospital with approximately 2,700 beds. A total of 3,030 events activated by a medical emergency team from March 1, 2008, to February 28, 2010. None. We collected data for all medical emergency team activations: patient characteristics, trigger type for medical emergency team (electronic medical record-based screening vs calling criteria), interventions during each event, outcomes of the medical emergency team intervention, and 28-day mortality after medical emergency team activation. We analyzed data for 2009, when the medical emergency team functioned 24 hours a day, 7 days a week (period 2), compared with that for 2008, when the medical emergency team functioned 12 hours a day, 7 days a week (period 1). The commonest cause of medical emergency team activation was respiratory distress (43.6%), and the medical emergency team performed early goal-directed therapy (21.3%), respiratory care (19.9%), and difficult airway management (12.3%). For patients on general wards, 51.3% (period 1) and 38.4% (period 2) of medical emergency team activations were triggered by the electronic medical record-based screening system (electronic medical record-triggered group). In 23.4%, activation occurred because of an abnormality in laboratory screening criteria. The commonest activation criterion from electronic medical record-based screening was respiratory rate (39.4%). Over half the patients were treated in the general ward, and one third of the patients were transferred to the ICU. The electronic medical record-triggered group had lower ICU admission with an odds ratio of 0.35 (95% CI, 0.22-0.55). In surgical patients, the electronic medical record-triggered group showed the lower 28-day mortality (10.5%) compared with the call-triggered group (26.7%) or the double-triggered group (33.3%) (odds ratio 0.365 with 95% CI, 0.154-0.867, p = 0.022). We successful managed the medical emergency team with electronic medical record-based screening criteria and a skilled intervention team. The electronic medical record-triggered group had lower ICU admission than the call-triggered group or the double-triggered group. In surgical patients, the electronic medical record-triggered group showed better outcome than other groups.

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

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

PubMed

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

2018-04-01

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

Telematics and satellites. Part 1: Information systems

NASA Astrophysics Data System (ADS)

Burke, W. R.

1980-06-01

Telematic systems are identified and described. The applications are examined emphasizing the role played by satellite links. The discussion includes file transfer, examples of distributed processor systems, terminal communication, information retrieval systems, office information systems, electronic preparation and publishing of information, electronic systems for transfer of funds, electronic mail systems, record file transfer characteristics, intra-enterprise networks, and inter-enterprise networks.

Assessment of Pharmacy Information System Performance in Three Hospitals in Eastern Province, Saudi Arabia

PubMed Central

El.Mahalli, Azza; El-Khafif, Sahar H.; Yamani, Wid

2016-01-01

The pharmacy information system is one of the central pillars of a hospital information system. This research evaluated a pharmacy information system according to six aspects of the medication process in three hospitals in Eastern Province, Saudi Arabia. System administrators were interviewed to determine availability of functionalities. Then, system users within the hospital were targeted to evaluate their level of usage of these functionalities. The study was cross-sectional. Two structured surveys were designed. The overall response rate of hospital users was 31.7 percent. In all three hospitals studied, the electronic health record is hybrid, implementation has been completed and the system is running, and the systems have computerized provider order entry and clinical decision support. Also, the pharmacy information systems are integrated with the electronic health record, and computerized provider order entry and almost all prescribing and transcription functionalities are available; however, drug dispensing is a mostly manual process. However, the study hospitals do not use barcode-assisted medication administration systems to verify patient identity and electronically check dose administration, and none of them have computerized adverse drug event monitoring that uses the electronic health record. The numbers of users who used different functionalities most or all of the time was generally low. The highest frequency of utilization was for patient administration records (56.8 percent), and the lowest was for linkage of the pharmacy information system to pharmacy stock (9.1 percent). Encouraging users to use different functionalities was highly recommended. PMID:26903780

Assessment of Pharmacy Information System Performance in Three Hospitals in Eastern Province, Saudi Arabia.

PubMed

El Mahalli, Azza; El-Khafif, Sahar H; Yamani, Wid

2016-01-01

The pharmacy information system is one of the central pillars of a hospital information system. This research evaluated a pharmacy information system according to six aspects of the medication process in three hospitals in Eastern Province, Saudi Arabia. System administrators were interviewed to determine availability of functionalities. Then, system users within the hospital were targeted to evaluate their level of usage of these functionalities. The study was cross-sectional. Two structured surveys were designed. The overall response rate of hospital users was 31.7 percent. In all three hospitals studied, the electronic health record is hybrid, implementation has been completed and the system is running, and the systems have computerized provider order entry and clinical decision support. Also, the pharmacy information systems are integrated with the electronic health record, and computerized provider order entry and almost all prescribing and transcription functionalities are available; however, drug dispensing is a mostly manual process. However, the study hospitals do not use barcode-assisted medication administration systems to verify patient identity and electronically check dose administration, and none of them have computerized adverse drug event monitoring that uses the electronic health record. The numbers of users who used different functionalities most or all of the time was generally low. The highest frequency of utilization was for patient administration records (56.8 percent), and the lowest was for linkage of the pharmacy information system to pharmacy stock (9.1 percent). Encouraging users to use different functionalities was highly recommended.

Implementation of the Agitated Behavior Scale in the Electronic Health Record.

PubMed

Wilson, Helen John; Dasgupta, Kritis; Michael, Kathleen

The purpose of the study was to implement an Agitated Behavior Scale through an electronic health record and to evaluate the usability of the scale in a brain injury unit at a rehabilitation hospital. A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants using convenience sampling. The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale. The Agitated Behavior Scale was found to be usable, and there was 92.2% compliance with the use of the electronic Electronic Agitated Behavior Scale. The Agitated Behavior Scale was effectively implemented in the electronic health record and was found to be usable in the assessment of agitation. Utilization of the scale through the electronic health record on a daily basis will allow for an early identification of agitation in patients with traumatic brain injury and enable prompt interventions to manage agitation.

76 FR 18738 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-05

... Records in the System: First, middle and last name, nickname, last four digits of Social Security Number..., Accessing, Retaining, and Disposing of Records: Storage: Records are stored on electronic storage media... characteristics (such as name, last four digits of Social Security Number (SSN), series, grade, dates of service...

76 FR 3111 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-19

.... Storage: Maintained in paper and electronic storage media. Retrievability: Retrieved by name and or Social... Program.'' Categories of records in the system: Delete entry and replace with ``Individual's name, Social..., and award records. Statement of good standing before the bar and other State Bar records, law school...

75 FR 36642 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-28

... relating to the issue, return, and accountability of keys to secure areas. Records may contain name, Social... disposing of records in the system: Storage: Paper records in file folders and electronic storage media. Retrievability: By name, Social Security Number (SSN), key number, personal identification number (PIN), Magnetic...

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

PubMed

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

2016-01-01

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

14 CFR § 1212.605 - Safeguarding information in systems of records.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Safeguarding information in systems of records. § 1212.605 Section § 1212.605 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE... Technology Security Officer for electronic records maintained in automated systems. Safeguards must insure...

77 FR 25993 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... disposing of records in the system: Storage: Electronic storage media. Retrievability: Name, Social Security... effective on June 1, 2012 unless comments are received which result in a contrary determination. ADDRESSES... records in the system: Name, Social Security Number (SSN), date of birth, home address, place of birth...

76 FR 77625 - Privacy Act of 1974, as Amended; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... rapid communication to registered FDIC personnel during and after emergency and security events to....'' This system will contain correspondence and other communications addressed or directed to FDIC OIG and..., RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: Storage: Records are stored in electronic media and in...

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

PubMed Central

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

2004-01-01

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

Are anesthesia start and end times randomly distributed? The influence of electronic records.

PubMed

Deal, Litisha G; Nyland, Michael E; Gravenstein, Nikolaus; Tighe, Patrick

2014-06-01

To perform a frequency analysis of start minute digits (SMD) and end minute digits (EMD) taken from the electronic, computer-assisted, and manual anesthesia billing-record systems. Retrospective cross-sectional review. University medical center. This cross-sectional review was conducted on billing records from a single healthcare institution over a 15-month period. A total of 30,738 cases were analyzed. For each record, the start time and end time were recorded. Distributions of SMD and EMD were tested against the null hypothesis of a frequency distribution equivalently spread between zero and nine. SMD and EMD aggregate distributions each differed from equivalency (P < 0.0001). When stratified by type of anesthetic record, no differences were found between the recorded and expected equivalent distribution patterns for electronic anesthesia records for start minute (P < 0.98) or end minute (P < 0.55). Manual and computer-assisted records maintained nonequivalent distribution patterns for SMD and EMD (P < 0.0001 for each comparison). Comparison of cumulative distributions between SMD and EMD distributions suggested a significant difference between the two patterns (P < 0.0001). An electronic anesthesia record system, with automated time capture of events verified by the user, produces a more unified distribution of billing times than do more traditional methods of entering billing times. Copyright © 2014 Elsevier Inc. All rights reserved.

36 CFR § 1236.12 - What other records management and preservation considerations must be incorporated into the...

Code of Federal Regulations, 2013 CFR

2013-07-01

... exchange of electronic documents between offices using different software or operating systems. ... of electronic information systems? § 1236.12 Section § 1236.12 Parks, Forests, and Public Property... Management and Preservation Considerations for Designing and Implementing Electronic Information Systems...

Electronic Medical Records and the Technological Imperative: The Retrieval of Dialogue in Community-Based Primary Care.

PubMed

Franz, Berkeley; Murphy, John W

2015-01-01

Electronic medical records are regarded as an important tool in primary health-care settings. Because these records are thought to standardize medical information, facilitate provider communication, and improve office efficiency, many practices are transitioning to these systems. However, much of the concern with improving the practice of record keeping has related to technological innovations and human-computer interaction. Drawing on the philosophical reflection raised in Jacques Ellul's work, this article questions the technological imperative that may be supporting medical record keeping. Furthermore, given the growing emphasis on community-based care, this article discusses important non-technological aspects of electronic medical records that might bring the use of these records in line with participatory primary-care medicine.

Mobile agent application and integration in electronic anamnesis system.

PubMed

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

2012-06-01

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

MDPHnet: Secure, Distributed Sharing of Electronic Health Record Data for Public Health Surveillance, Evaluation, and Planning

PubMed Central

Vogel, Joshua; Brown, Jeffrey S.; Land, Thomas; Platt, Richard

2014-01-01

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

A Development of Automatic Audit System for Written Informed Consent using Machine Learning.

PubMed

Yamada, Hitomi; Takemura, Tadamasa; Asai, Takahiro; Okamoto, Kazuya; Kuroda, Tomohiro; Kuwata, Shigeki

2015-01-01

In Japan, most of all the university and advanced hospitals have implemented both electronic order entry systems and electronic charting. In addition, all medical records are subjected to inspector audit for quality assurance. The record of informed consent (IC) is very important as this provides evidence of consent from the patient or patient's family and health care provider. Therefore, we developed an automatic audit system for a hospital information system (HIS) that is able to evaluate IC automatically using machine learning.

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

PubMed

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

2017-01-01

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

Inter-professional electronic documents and child health: a study of persisting non-electronic communication in the use of electronic documents.

PubMed

Saario, Sirpa; Hall, Christopher; Peckover, Sue

2012-12-01

Information and communication technologies are widely used in health and social care settings to replace previous means of record keeping, assessment and communication. Commentary on the strengths and weaknesses of such systems abound, thus it is useful to examine how they are used in practice. This article draws on findings from two separate studies, conducted between 2005 and 2007, which examined how child health and welfare professionals use electronic documents in Finland and England. Known respectively as Miranda and CAF, these systems are different in terms of structure and function but in their everyday use common features are identified, notably the continued use of and reliance on non-electronic means of communication. Based on interviews with professionals, three forms of non-electronic communication are described: alternative records, phone calls and letters, which facilitate the sharing of the electronic record. Finally, the electronic documents are further analysed as potential boundary objects which aim to create common understanding between sites and professionals. Copyright © 2012 Elsevier Ltd. All rights reserved.

Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation

PubMed Central

Sefton, Gerri; Lane, Steven; Killen, Roger; Black, Stuart; Lyon, Max; Ampah, Pearl; Sproule, Cathryn; Loren-Gosling, Dominic; Richards, Caitlin; Spinty, Jean; Holloway, Colette; Davies, Coral; Wilson, April; Chean, Chung Shen; Carter, Bernie; Carrol, E.D.

2017-01-01

Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined “norm.” Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team. PMID:27832032

Implementing an overdose education and naloxone distribution program in a health system.

PubMed

Devries, Jennifer; Rafie, Sally; Polston, Gregory

To design and implement a health system-wide program increasing provision of take-home naloxone in patients at risk for opioid overdose, with the downstream aim of reducing fatalities. The program includes health care professional education and guidelines, development, and dissemination of patient education materials, electronic health record changes to promote naloxone prescriptions, and availability of naloxone in pharmacies. Academic health system, San Diego, California. University of California, San Diego Health (UCSDH), offers both inpatient and outpatient primary care and specialty services with 563 beds spanning 2 hospitals and 6 pharmacies. UCSDH is part of the University of California health system, and it serves as the county's safety net hospital. In January 2016, a multisite academic health system initiated a system-wide overdose education and naloxone distribution program to prevent opioid overdose and opioid overdose-related deaths. An interdisciplinary, interdepartmental team came together to develop and implement the program. To strengthen institutional support, naloxone prescribing guidelines were developed and approved for the health system. Education on naloxone for physicians, pharmacists, and nurses was provided through departmental trainings, bulletins, and e-mail notifications. Alerts in the electronic health record and preset naloxone orders facilitated co-prescribing of naloxone with opioid prescriptions. Electronic health record reports captured naloxone prescriptions ordered. Summary reports on the electronic health record measured naloxone reminder alerts and response rates. Since the start of the program, the health system has trained 252 physicians, pharmacists, and nurses in overdose education and take-home naloxone. There has been an increase in the number of prescriptions for naloxone from a baseline of 4.5 per month to an average of 46 per month during the 3 months following full implementation of the program including implementation of electronic health record alerts. Initiating and implementing an overdose education and naloxone distribution program is feasible in an academic health system. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study

PubMed Central

Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-01-01

Background The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. Objective We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. Methods We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. PMID:29669709

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

NASA Astrophysics Data System (ADS)

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

1997-05-01

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

10 CFR 850.39 - Recordkeeping and use of information.

Code of Federal Regulations, 2010 CFR

2010-01-01

... must maintain all records required by this part in current and accessible electronic systems, which... Prevention Programs, Office of Health, Safety and Security an electronic registry of beryllium-associated... maintain accurate records of all beryllium inventory information, hazard assessments, exposure measurements...

78 FR 78512 - Privacy Act of 1974, as Amended; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... Purpose(s): The purpose of this system of records is to establish a manual and electronic database that..., identity theft or fraud, or harm to the security or integrity of this system or other systems or programs...

Clinical Assistant Diagnosis for Electronic Medical Record Based on Convolutional Neural Network.

PubMed

Yang, Zhongliang; Huang, Yongfeng; Jiang, Yiran; Sun, Yuxi; Zhang, Yu-Jin; Luo, Pengcheng

2018-04-20

Automatically extracting useful information from electronic medical records along with conducting disease diagnoses is a promising task for both clinical decision support(CDS) and neural language processing(NLP). Most of the existing systems are based on artificially constructed knowledge bases, and then auxiliary diagnosis is done by rule matching. In this study, we present a clinical intelligent decision approach based on Convolutional Neural Networks(CNN), which can automatically extract high-level semantic information of electronic medical records and then perform automatic diagnosis without artificial construction of rules or knowledge bases. We use collected 18,590 copies of the real-world clinical electronic medical records to train and test the proposed model. Experimental results show that the proposed model can achieve 98.67% accuracy and 96.02% recall, which strongly supports that using convolutional neural network to automatically learn high-level semantic features of electronic medical records and then conduct assist diagnosis is feasible and effective.

Use of electronic health records can improve the health care industry's environmental footprint.

PubMed

Turley, Marianne; Porter, Catherine; Garrido, Terhilda; Gerwig, Kathy; Young, Scott; Radler, Linda; Shaber, Ruth

2011-05-01

Electronic health records have the potential to improve the environmental footprint of the health care industry. We estimate that Kaiser Permanente's electronic health record system, which covers 8.7 million beneficiaries, eliminated 1,000 tons of paper records and 68 tons of x-ray film, and that it has lowered gasoline consumption among patients who otherwise would have made trips to the doctor by at least three million gallons per year. However, the use of personal computers resulted in higher energy consumption and generated an additional 250 tons of waste. We conclude that electronic health records have a positive net effect on the environment, and that our model for evaluating their impact can be used to determine whether their use can improve communities' health.

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

PubMed

Winkelman, Warren J; Leonard, Kevin J

2004-01-01

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

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

ERIC Educational Resources Information Center

Riddick, William P.

2013-01-01

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

Implementation of Imaging Technology for Recordkeeping at the World Bank.

ERIC Educational Resources Information Center

Smith, Clive D.

1997-01-01

Describes the evolution of an electronic document management system for the World Bank, including record-keeping components, and how the Pittsburgh requirements for evidence in record keeping were used to evaluate it. Discusses imaging technology for scanning paper records, metadata for retrieval and record keeping, and extending the system to…

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.

76 FR 52320 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-22

..., or other clinical circumstances as defined by system requirements. To provide a data warehouse... Defense. DHA 23 System name: Pharmacy Data Transaction Service (PDTS). System location: Primary: Emdeon... retail pharmacy network, and commercial pharmacies. Categories of records in the system: Electronic data...

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

PubMed

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

2003-03-01

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

Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems.

PubMed

Shah, Gulzar H; Leider, Jonathon P; Castrucci, Brian C; Williams, Karmen S; Luo, Huabin

2016-01-01

Assessing local health departments' (LHDs') informatics capacities is important, especially within the context of broader, systems-level health reform. We assessed a nationally representative sample of LHDs' adoption of information systems and the factors associated with adoption and implementation by examining electronic health records, health information exchange, immunization registry, electronic disease reporting system, and electronic laboratory reporting. We used data from the National Association of County and City Health Officials' 2013 National Profile of LHDs. We performed descriptive statistics and multinomial logistic regression for the five implementation-oriented outcome variables of interest, with three levels of implementation (implemented, plan to implement, and no activity). Independent variables included infrastructural and financial capacity and other characteristics associated with informatics capacity. Of 505 LHDs that responded to the survey, 69 (13.5%) had implemented health information exchanges, 122 (22.2%) had implemented electronic health records, 245 (47.5%) had implemented electronic laboratory reporting, 368 (73.0%) had implemented an electronic disease reporting system, and 416 (83.8%) had implemented an immunization registry. LHD characteristics associated with health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, health information systems specialists on staff, larger population size, decentralized governance system, one or more local boards of health, metropolitan jurisdiction, and top executive with more years in the job. Many LHDs lack health informatics capacity, particularly in smaller, rural jurisdictions. Cross-jurisdictional sharing, investment in public health informatics infrastructure, and additional training may help address these shortfalls.

A computerized Langmuir probe system

NASA Astrophysics Data System (ADS)

Pilling, L. S.; Bydder, E. L.; Carnegie, D. A.

2003-07-01

For low pressure plasmas it is important to record entire single or double Langmuir probe characteristics accurately. For plasmas with a depleted high energy tail, the accuracy of the recorded ion current plays a critical role in determining the electron temperature. Even for high density Maxwellian distributions, it is necessary to accurately model the ion current to obtain the correct electron density. Since the electron and ion current saturation values are, at best, orders of magnitude apart, a single current sensing resistor cannot provide the required resolution to accurately record these values. We present an automated, personal computer based data acquisition system for the determination of fundamental plasma properties in low pressure plasmas. The system is designed for single and double Langmuir probes, whose characteristics can be recorded over a bias voltage range of ±70 V with 12 bit resolution. The current flowing through the probes can be recorded within the range of 5 nA-100 mA. The use of a transimpedance amplifier for current sensing eliminates the requirement for traditional current sensing resistors and hence the need to correct the raw data. The large current recording range is realized through the use of a real time gain switching system in the negative feedback loop of the transimpedance amplifier.

77 FR 26791 - Records Schedules; Availability and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

...-374- 09-7, 1 item, 1 temporary item). Master files of an electronic information system containing...-2012-0006, 1 item, 1 temporary item). Master files of an electronic information system used to document...-0001, 2 items, 2 temporary items). Master files and outputs of an electronic information system used to...

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

PubMed

Chen, Wei; Shih, Chien-Chou

2012-02-01

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

Large-Scale Document Automation: The Systems Integration Issue.

ERIC Educational Resources Information Center

Kalthoff, Robert J.

1985-01-01

Reviews current technologies for electronic imaging and its recording and transmission, including digital recording, optical data disks, automated image-delivery micrographics, high-density-magnetic recording, and new developments in telecommunications and computers. The role of the document automation systems integrator, who will bring these…

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

PubMed

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

2016-04-01

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

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

PubMed Central

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

2014-01-01

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

Use of large electronic health record databases for environmental epidemiology studies.

EPA Science Inventory

Background: Electronic health records (EHRs) are a ubiquitous component of the United States healthcare system and capture nearly all data collected in a clinic or hospital setting. EHR databases are attractive for secondary data analysis as they may contain detailed clinical rec...

75 FR 62149 - Records Schedules; Availability and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-07

... publications through the editorial process and capture bibliographic information for printed publications. 7... electronic data relating to persons of interest when the data relates to unique and significant intelligence... records of an electronic information system used to access intelligence and investigative data. 22...

Self-adhesive epidermal carbon nanotube electronics for tether-free long-term continuous recording of biosignals

NASA Astrophysics Data System (ADS)

Lee, Seung Min; Byeon, Hang Jin; Lee, Joong Hoon; Baek, Dong Hyun; Lee, Kwang Ho; Hong, Joung Sook; Lee, Sang-Hoon

2014-08-01

The long-term, continuous, inconspicuous, and noiseless monitoring of bioelectrical signals is critical to the early diagnosis of disease and monitoring health and wellbeing. However, it is a major challenge to record the bioelectrical signals of patients going about their daily lives because of the difficulties of integrating skin-like conducting materials, the measuring system, and medical technologies in a single platform. In this study, we developed a thin epidermis-like electronics that is capable of repeated self-adhesion onto skin, integration with commercial electronic components through soldering, and conformal contact without serious motion artifacts. Using well-mixed carbon nanotubes and adhesive polydimethylsiloxane, we fabricated an epidermal carbon nanotube electronics which maintains excellent conformal contact even within wrinkles in skin, and can be used to record electrocardiogram signals robustly. The electrode is biocompatible and can even be operated in water, which means patients can live normal lives despite wearing a complicated recording system.

Improving quality: bridging the health sector divide.

PubMed

Pringle, Mike

2003-12-01

All too often, quality assurance looks at just one small part of the complex system that is health care. However, evidently each individual patient has one set of experiences and outcomes, often involving a range of health professionals in a number of settings across multiple sectors. In order to solve the problems of this complexity, we need to establish high-quality electronic recording in each of the settings. In the UK, primary care has been leading the way in adopting information technology and can now use databases for individual clinical care, for quality assurance using significant event and conventional auditing, and for research. Before we can understand and quality-assure the whole health care system, we need electronic patient records in all settings and good communication to build a summary electronic health record for each patient. Such an electronic health record will be under the control of the patient concerned, will be shared with the explicit consent of the patient, and will form the vehicle for quality assurance across all sectors of the health service.

Self-adhesive epidermal carbon nanotube electronics for tether-free long-term continuous recording of biosignals

PubMed Central

Lee, Seung Min; Byeon, Hang Jin; Lee, Joong Hoon; Baek, Dong Hyun; Lee, Kwang Ho; Hong, Joung Sook; Lee, Sang-Hoon

2014-01-01

The long-term, continuous, inconspicuous, and noiseless monitoring of bioelectrical signals is critical to the early diagnosis of disease and monitoring health and wellbeing. However, it is a major challenge to record the bioelectrical signals of patients going about their daily lives because of the difficulties of integrating skin-like conducting materials, the measuring system, and medical technologies in a single platform. In this study, we developed a thin epidermis-like electronics that is capable of repeated self-adhesion onto skin, integration with commercial electronic components through soldering, and conformal contact without serious motion artifacts. Using well-mixed carbon nanotubes and adhesive polydimethylsiloxane, we fabricated an epidermal carbon nanotube electronics which maintains excellent conformal contact even within wrinkles in skin, and can be used to record electrocardiogram signals robustly. The electrode is biocompatible and can even be operated in water, which means patients can live normal lives despite wearing a complicated recording system. PMID:25123356

Simplifying ART cohort monitoring: can pharmacy stocks provide accurate estimates of patients retained on antiretroviral therapy in Malawi?

PubMed

Tweya, Hannock; Feldacker, Caryl; Ben-Smith, Anne; Harries, Anthony D; Komatsu, Ryuichi; Jahn, Andreas; Phiri, Sam; Tassie, Jean-Michel

2012-07-20

Routine monitoring of patients on antiretroviral therapy (ART) is crucial for measuring program success and accurate drug forecasting. However, compiling data from patient registers to measure retention in ART is labour-intensive. To address this challenge, we conducted a pilot study in Malawi to assess whether patient ART retention could be determined using pharmacy records as compared to estimates of retention based on standardized paper- or electronic based cohort reports. Twelve ART facilities were included in the study: six used paper-based registers and six used electronic data systems. One ART facility implemented an electronic data system in quarter three and was included as a paper-based system facility in quarter two only. Routine patient retention cohort reports, paper or electronic, were collected from facilities for both quarter two [April-June] and quarter three [July-September], 2010. Pharmacy stock data were also collected from the 12 ART facilities over the same period. Numbers of ART continuation bottles recorded on pharmacy stock cards at the beginning and end of each quarter were documented. These pharmacy data were used to calculate the total bottles dispensed to patients in each quarter with intent to estimate the number of patients retained on ART. Information for time required to determine ART retention was gathered through interviews with clinicians tasked with compiling the data. Among ART clinics with paper-based systems, three of six facilities in quarter two and four of five facilities in quarter three had similar numbers of patients retained on ART comparing cohort reports to pharmacy stock records. In ART clinics with electronic systems, five of six facilities in quarter two and five of seven facilities in quarter three had similar numbers of patients retained on ART when comparing retention numbers from electronically generated cohort reports to pharmacy stock records. Among paper-based facilities, an average of 13 4 hours was needed to calculate patient retention for cohort reporting using patient registers as compared to 2.25 hours using pharmacy stock cards. The numbers of patients retained on ART as estimated using pharmacy stock records were largely similar to estimates based on either paper registers or electronic data system. Furthermore, less time and staff effort was needed to estimate ART patient retention using pharmacy stock records versus paper-based registers. Reinforcing ARV stock management may improve the precision of estimates.

Noise reduction in negative-ion quadrupole mass spectrometry

DOEpatents

Chastagner, P.

1993-04-20

A quadrupole mass spectrometer (QMS) system is described having an ion source, quadrupole mass filter, and ion collector/recorder system. A weak, transverse magnetic field and an electron collector are disposed between the quadrupole and ion collector. When operated in negative ion mode, the ion source produces a beam of primarily negatively-charged particles from a sample, including electrons as well as ions. The beam passes through the quadrupole and enters the magnetic field, where the electrons are deflected away from the beam path to the electron collector. The negative ions pass undeflected to the ion collector where they are detected and recorded as a mass spectrum.

Noise reduction in negative-ion quadrupole mass spectrometry

DOEpatents

Chastagner, Philippe

1993-01-01

A quadrupole mass spectrometer (QMS) system having an ion source, quadrupole mass filter, and ion collector/recorder system. A weak, transverse magnetic field and an electron collector are disposed between the quadrupole and ion collector. When operated in negative ion mode, the ion source produces a beam of primarily negatively-charged particles from a sample, including electrons as well as ions. The beam passes through the quadrupole and enters the magnetic field, where the electrons are deflected away from the beam path to the electron collector. The negative ions pass undeflected to the ion collector where they are detected and recorded as a mass spectrum.

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

PubMed Central

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

2010-01-01

Objectives To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service. Design A mixed methods, longitudinal, multisite, socio-technical case study. Setting Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete. Data sources and analysis Dataset for the evaluation consists of semi-structured interviews, documents and field notes, observations, and quantitative data. Qualitative data were analysed thematically with a socio-technical coding matrix, combined with additional themes that emerged from the data. Main results Hospital electronic health record applications are being developed and implemented far more slowly than was originally envisioned; the top-down, standardised approach has needed to evolve to admit more variation and greater local choice, which hospital trusts want in order to support local activity. Despite considerable delays and frustrations, support for electronic health records remains strong, including from NHS clinicians. Political and financial factors are now perceived to threaten nationwide implementation of electronic health records. Interviewees identified a range of consequences of long term, centrally negotiated contracts to deliver the NHS Care Records Service in secondary care, particularly as NHS trusts themselves are not party to these contracts. These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities. Our data suggest support for a “middle-out” approach to implementing hospital electronic health records, combining government direction with increased local autonomy, and for restricting detailed electronic health record sharing to local health communities. Conclusions Experiences from the early implementation sites, which have received considerable attention, financial investment and support, indicate that delivering improved healthcare through nationwide electronic health records will be a long, complex, and iterative process requiring flexibility and local adaptability both with respect to the systems and the implementation strategy. The more tailored, responsive approach that is emerging is becoming better aligned with NHS organisations’ perceived needs and is, if pursued, likely to deliver clinically useful electronic health record systems. PMID:20813822

Defining and incorporating basic nursing care actions into the electronic health record.

PubMed

Englebright, Jane; Aldrich, Kelly; Taylor, Cathy R

2014-01-01

To develop a definition of basic nursing care for the hospitalized adult patient and drive uptake of that definition through the implementation of an electronic health record. A team of direct care nurses, assisted by subject matter experts, analyzed nursing theory and regulatory requirements related to basic nursing care. The resulting list of activities was coded using the Clinical Care Classification (CCC) system and incorporated into the electronic health record system of a 170-bed community hospital. Nine basic nursing care activities were identified as a result of analyzing nursing theory and regulatory requirements in the framework of a hypothetical "well" patient. One additional basic nursing care activity was identified following the pilot implementation in the electronic health record. The pilot hospital has successfully passed a post-implementation regulatory review with no recommendations related to the documentation of basic patient care. This project demonstrated that it is possible to define the concept of basic nursing care and to distinguish it from the interdisciplinary, problem-focused plan of care. The use of the electronic health record can help clarify, document, and communicate basic care elements and improve uptake among nurses. This project to define basic nursing care activities and incorporate into the electronic health record represents a first step in capturing meaningful data elements. When fully implemented, these data could be translated into knowledge for improving care outcomes and collaborative processes. © 2013 Sigma Theta Tau International.

Maximum Acceleration Recording Circuit

NASA Technical Reports Server (NTRS)

Bozeman, Richard J., Jr.

1995-01-01

Coarsely digitized maximum levels recorded in blown fuses. Circuit feeds power to accelerometer and makes nonvolatile record of maximum level to which output of accelerometer rises during measurement interval. In comparison with inertia-type single-preset-trip-point mechanical maximum-acceleration-recording devices, circuit weighs less, occupies less space, and records accelerations within narrower bands of uncertainty. In comparison with prior electronic data-acquisition systems designed for same purpose, circuit simpler, less bulky, consumes less power, costs and analysis of data recorded in magnetic or electronic memory devices. Circuit used, for example, to record accelerations to which commodities subjected during transportation on trucks.

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

PubMed

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

2018-04-23

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

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

PubMed

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

2018-05-03

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

42 CFR 495.346 - Access to systems and records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Access to systems and records. 495.346 Section 495.346 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE...

12 CFR 205.13 - Administrative enforcement; record retention.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 2 2011-01-01 2011-01-01 false Administrative enforcement; record retention. 205.13 Section 205.13 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM ELECTRONIC FUND TRANSFERS (REGULATION E) § 205.13 Administrative enforcement; record...

12 CFR 205.13 - Administrative enforcement; record retention.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Administrative enforcement; record retention. 205.13 Section 205.13 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM ELECTRONIC FUND TRANSFERS (REGULATION E) § 205.13 Administrative enforcement; record...

76 FR 28010 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

.../or electronic storage media. Retrievability: Individual's name and Social Security Number (SSN... changes will be effective on June 13, 2011 unless comments are received that would result in a contrary... with ``Records may be stored on paper and/ or electronic storage media.'' * * * * * Safeguards: Delete...

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

PubMed

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

2007-10-11

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

Electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity: a randomised controlled trial.

PubMed

Chung, Louisa Ming Yan; Law, Queenie Pui Sze; Fong, Shirley Siu Ming; Chung, Joanne Wai Yee

2014-08-01

This study's objective was to investigate whether use of an electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity levels compared to use of a food diary and no self-monitoring. Sixty adults aged 20-60 with a body mass index ≥25 were recruited and randomly assigned to one of three groups: a group using an electronic system (EG), a group using a food diary (FD) and a control group using nothing (CG) to record food intake. All participants took part in three 60-90 nutrition seminars and completed three questionnaires on general nutrition knowledge, habitual physical activity levels and eating attitudes at the beginning and end of the 12-week study. The pre- and post-test scores for each questionnaire were analysed using a paired sample t-test. Significant improvements in the domain of 'dietary recommendations' were found in the EG (p=0.009) and FD groups (p=0.046). Great improvements were found in 'sources of nutrients', 'choosing everyday foods' and 'diet-disease relationships' in EG and FD groups. EG group showed greater improvement in the work index and sport index. An electronic dietary recording system may improve eating and exercise behaviour in a self-monitoring process. Copyright © 2014 Elsevier Ltd. All rights reserved.

[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.

Assessment of data quality of and staff satisfaction with an electronic health record system in a developing country (Uganda): a qualitative and quantitative comparative study.

PubMed

Ndira, S P; Rosenberger, K D; Wetter, T

2008-01-01

To assess if electronic health record systems in developing countries can improve on timeliness, availability and accuracy of routine health reports and staff satisfaction after introducing the electronic system, compared to the paper-based alternative. The research was conducted with hospital staff of Tororo District Hospital in Uganda. A comparative intervention study with qualitative and quantitative methods was used to compare the paper-based (pre-test) to the electronic system (post-test) focusing on accuracy, availability and timeliness of monthly routine reports about mothers visiting the hospital; and staff satisfaction with the electronic system as outcome measures. Timeliness: pre-test 13 of 19 months delivered to the district timely, delivery dates for six months could not be established; post-test 100%. pre-test 79% of reports were present at the district health office; post-test 100%. Accuracy: pre-test 73.2% of selected reports could be independently confirmed as correct; post-test 71.2%. Difficulties were encountered in finding enough mothers through direct follow up to inquire on accuracy of information recorded about them. Staff interviews showed that the electronic system is appreciated by the majority of the hospital staff. Remaining obstacles include staff workload, power shortages, network breakdowns and parallel data entry (paper-based and electronic). While timeliness and availability improved, improvement of accuracy could not be established. Better approaches to ascertaining accuracy have to be devised, e.g. evaluation of intended use. For success, organizational, managerial and social challenges must be addressed beyond technical aspects.

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

PubMed

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

2014-12-12

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

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

PubMed

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

2013-06-01

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

Standards for the Analysis and Processing of Surface-Water Data and Information Using Electronic Methods

USGS Publications Warehouse

Sauer, Vernon B.

2002-01-01

Surface-water computation methods and procedures are described in this report to provide standards from which a completely automated electronic processing system can be developed. To the greatest extent possible, the traditional U. S. Geological Survey (USGS) methodology and standards for streamflow data collection and analysis have been incorporated into these standards. Although USGS methodology and standards are the basis for this report, the report is applicable to other organizations doing similar work. The proposed electronic processing system allows field measurement data, including data stored on automatic field recording devices and data recorded by the field hydrographer (a person who collects streamflow and other surface-water data) in electronic field notebooks, to be input easily and automatically. A user of the electronic processing system easily can monitor the incoming data and verify and edit the data, if necessary. Input of the computational procedures, rating curves, shift requirements, and other special methods are interactive processes between the user and the electronic processing system, with much of this processing being automatic. Special computation procedures are provided for complex stations such as velocity-index, slope, control structures, and unsteady-flow models, such as the Branch-Network Dynamic Flow Model (BRANCH). Navigation paths are designed to lead the user through the computational steps for each type of gaging station (stage-only, stagedischarge, velocity-index, slope, rate-of-change in stage, reservoir, tide, structure, and hydraulic model stations). The proposed electronic processing system emphasizes the use of interactive graphics to provide good visual tools for unit values editing, rating curve and shift analysis, hydrograph comparisons, data-estimation procedures, data review, and other needs. Documentation, review, finalization, and publication of records are provided for with the electronic processing system, as well as archiving, quality assurance, and quality control.

Dutch virtual integration of healthcare information.

PubMed

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

2007-01-01

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

Implementing electronic identification for performance recording in sheep: II. Cost-benefit analysis in meat and dairy farms.

PubMed

Ait-Saidi, A; Caja, G; Salama, A A K; Milán, M J

2014-12-01

Costs and secondary benefits of implementing electronic identification (e-ID) for performance recording (i.e., lambing, body weight, inventory, and milk yield) in dairy and meat ewes were assessed by using the results from a previous study in which manual (M), semiautomatic (SA), and automatic (AU) data collection systems were compared. Ewes were identified with visual ear tags and electronic rumen boluses. The M system used visual identification, on-paper data recording, and manual data uploading to a computer. The SA system used e-ID with a handheld reader in which performances were typed and automatic uploaded to a computer. The use of a personal digital assistant (PDA) for recording and automatic data uploading, which transformed M in a SA system, was also considered. The AU system was only used for BW recording and consisted of e-ID, automatic data recording in an electronic scale, and uploading to a computer. The cost-benefit study was applied to 2 reference sheep farms of 700 meat ewes, under extensive or intensive production systems, and of 400 dairy ewes, practicing once- or twice-a-day machine milkings. Sensitivity analyses under voluntary and mandatory e-ID scenarios were also included. Benefits of using e-ID for SA or AU performance recording mainly depended on sheep farm purpose, number of test days per year, handheld reader and PDA prices, and flock size. Implementing e-ID for SA and AU performance recording saved approximately 50% of the time required by the M system, and increased the reliability of the data collected. Use of e-ID increased the cost of performance recording in a voluntary e-ID scenario, paying only partially the investment made (15 to 70%). For the mandatory e-ID scenario, in which the cost of e-ID devices was not included, savings paid 100% of the extra costs needed for using e-ID in all farm types and conditions. In both scenarios, the reader price was the most important extra cost (40 to 90%) for implementing e-ID in sheep farms. Calculated extra costs of using the PDA covered more than 100% of the implementation costs in all type of sheep farms, indicating that this device was cost-effective for sheep-performance recording. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Health care quality measures for children and adolescents in Foster Care: feasibility testing in electronic records.

PubMed

Deans, Katherine J; Minneci, Peter C; Nacion, Kristine M; Leonhart, Karen; Cooper, Jennifer N; Scholle, Sarah Hudson; Kelleher, Kelly J

2018-02-22

Preventive quality measures for the foster care population are largely untested. The objective of the study is to identify healthcare quality measures for young children and adolescents in foster care and to test whether the data required to calculate these measures can be feasibly extracted and interpreted within an electronic health records or within the Statewide Automated Child Welfare Information System. The AAP Recommendations for Preventive Pediatric Health Care served as the guideline for determining quality measures. Quality measures related to well child visits, developmental screenings, immunizations, trauma-related care, BMI measurements, sexually transmitted infections and depression were defined. Retrospective chart reviews were performed on a cohort of children in foster care from a single large pediatric institution and related county. Data available in the Ohio Statewide Automated Child Welfare Information System was compared to the same population studied in the electronic health record review. Quality measures were calculated as observed (received) to expected (recommended) ratios (O/E ratios) to describe the actual quantity of recommended health care that was received by individual children. Electronic health records and the Statewide Automated Child Welfare Information System data frequently lacked important information on foster care youth essential for calculating the measures. Although electronic health records were rich in encounter specific clinical data, they often lacked custodial information such as the dates of entry into and exit from foster care. In contrast, Statewide Automated Child Welfare Information System included robust data on custodial arrangements, but lacked detailed medical information. Despite these limitations, several quality measures were devised that attempted to accommodate these limitations. In this feasibility testing, neither the electronic health records at a single institution nor the county level Statewide Automated Child Welfare Information System was able to independently serve as a reliable source of data for health care quality measures for foster care youth. However, the ability to leverage both sources by matching them at an individual level may provide the complement of data necessary to assess the quality of healthcare.

76 FR 32355 - Privacy Act of 1974: New System Of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-06

... following data fields: Full name; Social Security number; date of birth; signature; image (photograph..., RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Records are stored in electronic media or in... retrievable by name, Social Security number, other ID number, PIV card serial number, image (photograph), and...

75 FR 52797 - State-68, Office of the Coordinator for Reconstruction and Stabilization Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

...-military exercises. CATEGORIES OF RECORDS IN THE SYSTEM: Name; Social Security number; date of birth..., RETAINING AND DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Electronic media. RETRIEVABILITY: Individual's... International Development (USAID) personnel will be allowed to access the CRC database in order to run the...

10 CFR 34.89 - Location of documents and records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... problems identified in daily checks of equipment as required by § 34.73(a); (5) Records of alarm system and... as pocket dosimeter and/or electronic personal dosimeters readings as required by § 34.83; (7... calibrations of alarm ratemeters and operability checks of pocket dosimeters and/or electronic personal...

10 CFR 34.89 - Location of documents and records.

Code of Federal Regulations, 2011 CFR

2011-01-01

... problems identified in daily checks of equipment as required by § 34.73(a); (5) Records of alarm system and... as pocket dosimeter and/or electronic personal dosimeters readings as required by § 34.83; (7... calibrations of alarm ratemeters and operability checks of pocket dosimeters and/or electronic personal...

DIRECT secure messaging as a common transport layer for reporting structured and unstructured lab results to outpatient providers.

PubMed

Sujansky, Walter; Wilson, Tom

2015-04-01

This report describes a grant-funded project to explore the use of DIRECT secure messaging for the electronic delivery of laboratory test results to outpatient physicians and electronic health record systems. The project seeks to leverage the inherent attributes of DIRECT secure messaging and electronic provider directories to overcome certain barriers to the delivery of lab test results in the outpatient setting. The described system enables laboratories that generate test results as HL7 messages to deliver these results as structured or unstructured documents attached to DIRECT secure messages. The system automatically analyzes generated HL7 messages and consults an electronic provider directory to determine the appropriate DIRECT address and delivery format for each indicated recipient. The system also enables lab results delivered to providers as structured attachments to be consumed by HL7 interface engines and incorporated into electronic health record systems. Lab results delivered as unstructured attachments may be printed or incorporated into patient records as PDF files. The system receives and logs acknowledgement messages to document the status of each transmitted lab result, and a graphical interface allows searching and review of this logged information. The described system is a fully implemented prototype that has been tested in a laboratory setting. Although this approach is promising, further work is required to pilot test the system in production settings with clinical laboratories and outpatient provider organizations. Copyright © 2015 Elsevier Inc. All rights reserved.

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

PubMed Central

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

2013-01-01

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

Document Storage and Retrieval in the Electronic Office.

ERIC Educational Resources Information Center

Ashford, John

1985-01-01

Proposals are made for practical approaches to the design of electronic office systems to provide for the effective storage and retrieval of the documents that they generate. Problems of records management and requirements to be met by the designer of an electronic office system are highlighted. Nineteen references are cited. (EJS)

Electronic Medical Business Operations System

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

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

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

Improving the Effectiveness of Electronic Health Record-Based Referral Processes

PubMed Central

2012-01-01

Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted “socio-technical” approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication. PMID:22973874

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.

77 FR 29619 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-18

... system: Name, Social Security Number (SSN), gender, race/ethnicity, birth date, place of birth, home..., spouse information, marital status, dependent child information (citizenship, gender, date of birth..., accessing, retaining, and disposing of records in the system: Storage: Electronic storage media...

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.

PubMed

Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-04-18

The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. ©Naomi Muinga, Steve Magare, Jonathan Monda, Onesmus Kamau, Stuart Houston, Hamish Fraser, John Powell, Mike English, Chris Paton. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.

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

PubMed

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

2015-08-01

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

Identification and Progression of Heart Disease Risk Factors in Diabetic Patients from Longitudinal Electronic Health Records.

PubMed

Jonnagaddala, Jitendra; Liaw, Siaw-Teng; Ray, Pradeep; Kumar, Manish; Dai, Hong-Jie; Hsu, Chien-Yeh

2015-01-01

Heart disease is the leading cause of death worldwide. Therefore, assessing the risk of its occurrence is a crucial step in predicting serious cardiac events. Identifying heart disease risk factors and tracking their progression is a preliminary step in heart disease risk assessment. A large number of studies have reported the use of risk factor data collected prospectively. Electronic health record systems are a great resource of the required risk factor data. Unfortunately, most of the valuable information on risk factor data is buried in the form of unstructured clinical notes in electronic health records. In this study, we present an information extraction system to extract related information on heart disease risk factors from unstructured clinical notes using a hybrid approach. The hybrid approach employs both machine learning and rule-based clinical text mining techniques. The developed system achieved an overall microaveraged F-score of 0.8302.

Electronic health record meets digital library: a new environment for achieving an old goal.

PubMed

Humphreys, B 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 encouragement 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.

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

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.

Using High-Technology Simulators to Prepare Anesthesia Providers Before Implementation of a New Electronic Health Record Module: A Technical Report.

PubMed

Weintraub, Ari Y; Deutsch, Ellen S; Hales, Roberta L; Buchanan, Newton A; Rock, Whitney L; Rehman, Mohamed A

2017-06-01

Learning to use a new electronic anesthesia information management system can be challenging. Documenting anesthetic events, medication administration, and airway management in an unfamiliar system while simultaneously caring for a patient with the vigilance required for safe anesthesia can be distracting and risky. This technical report describes a vendor-agnostic approach to training using a high-technology manikin in a simulated clinical scenario. Training was feasible and valued by participants but required a combination of electronic and manual components. Further exploration may reveal simulated patient care training that provides the greatest benefit to participants as well as feedback to inform electronic health record improvements.

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

PubMed

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

2014-01-01

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

Electronic reporting of all reference laboratory results: An important step toward a truly all-encompassing, integrated health record.

PubMed

Kratz, Alexander

2016-09-01

Results from reference laboratories are often not easily available in electronic health records. This article describes a multi-pronged, long-term approach that includes bringing send-out tests in-house, upgrading the laboratory information system, interfacing more send-out tests and more reference laboratories, utilizing the "miscellaneous assay" option offered by some reference laboratories, and scanning all remaining paper reports from reference laboratories for display in the electronic health record. This allowed all laboratory results obtained in association with a patient visit, whether performed in-house or at a reference laboratory, to be available in the integrated electronic health record. This was achieved without manual data entry of reference laboratory results, thereby avoiding the risk of transcription errors. A fully integrated electronic health record that contains all laboratory results can be achieved by maximizing the number of interfaced reference laboratory assays and making all non-interfaced results available as scanned documents. © The Author(s) 2015.

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

PubMed

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

2017-11-01

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

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.

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.

Policy and system strategies in promoting child health information systems, including the role of Medicaid, the state children's health insurance program, and public financing.

PubMed

MacTaggart, Patricia; Bagley, Bruce

2009-01-01

Government, through its unique roles as regulator, purchaser, provider, and facilitator, has an opportunity and an obligation to play a major role in accelerating the implementation of electronic health record systems and electronic health information exchange. Providers, who are expected to deliver appropriate care at designated locations at an appropriate cost, are dependent on health information technology for efficient effective health care. As state and federal governments move forward with health care purchasing reforms, they must take the opportunity to leverage policy and structure and to align incentives that enhance the potential for provider engagement in electronic health record adoption.

An analysis of electronic document management in oncology care.

PubMed

Poulter, Thomas; Gannon, Brian; Bath, Peter A

2012-06-01

In this research in progress, a reference model for the use of electronic patient record (EPR) systems in oncology is described. The model, termed CICERO, comprises technical and functional components, and emphasises usability, clinical safety and user acceptance. One of the functional components of the model-an electronic document and records management (EDRM) system-is monitored in the course of its deployment at a leading oncology centre in the UK. Specifically, the user requirements and design of the EDRM solution are described.The study is interpretative and forms part a wider research programme to define and validate the CICERO model. Preliminary conclusions confirm the importance of a socio-technical perspective in Onco-EPR system design.

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

PubMed Central

Winkelman, Warren J.; Leonard, Kevin J.

2004-01-01

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

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

PubMed

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

2013-06-01

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

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

PubMed Central

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

2013-01-01

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

Computer-Based Medical System

NASA Technical Reports Server (NTRS)

1998-01-01

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

Applications for detection of acute kidney injury using electronic medical records and clinical information systems: workgroup statements from the 15(th) ADQI Consensus Conference.

PubMed

James, Matthew T; Hobson, Charles E; Darmon, Michael; Mohan, Sumit; Hudson, Darren; Goldstein, Stuart L; Ronco, Claudio; Kellum, John A; Bagshaw, Sean M

2016-01-01

Electronic medical records and clinical information systems are increasingly used in hospitals and can be leveraged to improve recognition and care for acute kidney injury. This Acute Dialysis Quality Initiative (ADQI) workgroup was convened to develop consensus around principles for the design of automated AKI detection systems to produce real-time AKI alerts using electronic systems. AKI alerts were recognized by the workgroup as an opportunity to prompt earlier clinical evaluation, further testing and ultimately intervention, rather than as a diagnostic label. Workgroup members agreed with designing AKI alert systems to align with the existing KDIGO classification system, but recommended future work to further refine the appropriateness of AKI alerts and to link these alerts to actionable recommendations for AKI care. The consensus statements developed in this review can be used as a roadmap for development of future electronic applications for automated detection and reporting of AKI.

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

PubMed

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

2012-01-01

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

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

PubMed Central

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

2014-01-01

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

Long-Term Surveillance and Maintenance Records: Maintaining Access to the Knowledge - 13122

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

Montgomery, John; Gueretta, Jeanie; McKinney, Ruth

The U.S. Department of Energy (DOE) Office of Legacy Management (LM) is an integral part of DOE's strategy to ensure that legacy liabilities of former nuclear weapons production sites are properly managed following the completion of environmental cleanup activities. In the area of environmental legacy management, records management is crucial to the protection of health, environmental, and legal interests of the Department and the public. LM is responsible for maintaining long-term surveillance and maintenance (LTS and M) records in performance of its mission. Maintaining access to the knowledge contained in these record collections is one of LM's primary responsibilities. Tomore » fulfill this responsibility, LM established a consolidated records management facility, the LM Business Center (LMBC), to house physical media records and electronic records. A new electronic record keeping system (ERKS) was needed to replace an obsolete system while helping to ensure LM is able to meet ongoing responsibilities to maintain access to knowledge and control the life cycle management of records. (authors)« less

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…

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…

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…

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…

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

PubMed

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

2018-01-01

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

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

PubMed

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

2018-02-01

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

Use of Electronic Medication Administration Records to Reduce Perceived Stress and Risk of Medication Errors in Nursing Homes.

PubMed

Alenius, Malin; Graf, Peter

2016-07-01

Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P < .01 vs the control group). The perceived overall daily stress levels were also reduced in the intervention group (P < .05). These results indicate that the utilization of electronic medication administration records will reduce many of the concerns regarding the medication administration process.

Ubiquitous-Severance Hospital Project: Implementation and Results

PubMed Central

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

2010-01-01

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

Ubiquitous-severance hospital project: implementation and results.

PubMed

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

2010-03-01

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

36 CFR 1008.6 - Assuring integrity of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... subject to the Privacy Act be maintained with appropriate administrative, technical and physical...) Records security. Whether maintained in physical or electronic form, records subject to the Privacy Act... the system of records. The Privacy Act Officer will periodically review these security measures to...

Using computers in the exam room.

PubMed

McGrath, Debra

2009-01-01

Purchasing an electronic health records system is the first step to assimilation of the new system into the fabric of a practice. The next hurdle is use of the electronic health record as close to the point of patient care as possible, which requires the clinician to use a computer. This article presents some of the unique challenges of using computers to document patient encounters and some practical advice and considerations for improving the use of computers at the bedside.

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

PubMed

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

2008-06-01

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

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

PubMed

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

2016-12-01

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

75 FR 52993 - Records Schedules; Availability and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

... information system used to track case files involving internal agency investigations. 13. Department of... Inspection Service (N1-463-09-10, 1 item, 1 temporary item). Master files of an electronic information system... an electronic information system containing data that supports financial management and accounting...

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

PubMed

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

2009-04-01

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

75 FR 25219 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-07

... SYSTEM: Badge and vehicle control records that at a minimum include: Name, Social Security Number (SSN... SYSTEM: 10 U.S.C. 8013, Secretary of the Air Force, Powers and Duties; Department of Defense 5200.08-R... SYSTEM: STORAGE: Electronic storage media. RETRIEVABILITY: Data is retrieved by querying a driver's name...

Mark 3 wideband digital recorder in perspective

NASA Technical Reports Server (NTRS)

Hinteregger, H. F.

1980-01-01

The tape recorder used for the Mark 3 data acquisition and processing system is compared with earlier very long baseline interferometry recorders. Wideband 33-1/3 kbpi digital channel characteristics of instrumentation recorders and of a modern video cassette recorder are illustrated. Factors which influenced selection of the three major commercial components (transport, heads, and tape) are discussed. A brief functional description and the reasons for development of efficient signal electronics and necessary auxiliary control electronics are given. The design and operation of a digital bit synchronizer is illustrated as an example of the high degree of simplicity achieved.

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

NASA Astrophysics Data System (ADS)

Siegel, Eliot L.; Reiner, Bruce I.

2001-08-01

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

NASA STI Program Seminar: Electronic documents

NASA Technical Reports Server (NTRS)

1994-01-01

The theme of this NASA Scientific and Technical Information Program Seminar was electronic documents. Topics covered included Electronic Documents Management at the CASI, the Impact of Electronic Publishing on User Expectations and Searching Image Record Management, Secondary Publisher Considerations for Electronic Journal Literature, and the Technical Manual Publishing On Demand System (TMPODS).

Electronic Ambient-Temperature Recorder

NASA Technical Reports Server (NTRS)

Russell, Larry; Barrows, William

1995-01-01

Electronic temperature-recording unit stores data in internal memory for later readout. Records temperatures from minus 40 degrees to plus 60 degrees C at intervals ranging from 1.875 to 15 minutes. With all four data channels operating at 1.875-minute intervals, recorder stores at least 10 days' data. For only one channel at 15-minute intervals, capacity extends to up to 342 days' data. Developed for recording temperatures of instruments and life-science experiments on satellites, space shuttle, and high-altitude aircraft. Adaptable to such terrestrial uses as recording temperatures of perishable goods during transportation and of other systems or processes over long times. Can be placed directly in environment to monitor.

Evaluation of a Pilot Asthma Care Program for Electronic Communication between School Health and a Healthcare System's Electronic Medical Record.

PubMed

Reeves, Kelly W; Taylor, Yhenneko; Tapp, Hazel; Ludden, Thomas; Shade, Lindsay E; Burton, Beth; Courtlandt, Cheryl; Dulin, Michael

2016-10-19

Asthma is a common childhood chronic lung disease affecting greater than 10% of children in the United States. School nurses are in a unique position to close gaps in care. Indeed, effective asthma management is more likely to result when providers, family, and schools work together to optimize the patient's treatment plan. Currently, effective communication between schools and healthcare systems through electronic medical record (EMR) systems remains a challenge. The goal of this feasibility pilot was to link the school-based care team with primary care providers in the healthcare system network via electronic communication through the EMR, on behalf of pediatric asthma patients who had been hospitalized for an asthma exacerbation. The implementation process and the potential impact of the communication with providers on the reoccurrence of asthma exacerbations with the linked patients were evaluated. By engaging stakeholders from the school system and the healthcare system, we were able to collaboratively design a communication process and implement a pilot which demonstrated the feasibility of electronic communication between school nurses and primary care providers. Outcomes data was collected from the electronic medical record to examine the frequency of asthma exacerbations among patients with a message from their school nurse. The percent of exacerbations in the 12 months before and after electronic communication was compared using McNemar's test. The pilot system successfully established communication between the school nurse and primary care provider for 33 students who had been hospitalized for asthma and a decrease in hospital admissions was observed with students whose school nurse communicated through the EMR with the primary care provider. Findings suggest a collaborative model of care that is enhanced through electronic communication via the EMR could positively impact the health of children with asthma or other chronic illnesses.

20 CFR 401.95 - Fees.

Code of Federal Regulations, 2010 CFR

2010-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION PRIVACY AND DISCLOSURE OF OFFICIAL RECORDS AND INFORMATION The Privacy Act § 401.95 Fees. (a) Policy. Where applicable, we will charge fees for copying records in... system of records, whether the search is manual, mechanical, or electronic. Where we must copy the record...

75 FR 13088 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-18

... action would be effective without further notice on April 19, 2010 unless comments are received which..., Social Security Number (SSN) and sponsoring DoD office. AUTHORITY FOR MAINTENANCE OF THE SYSTEM: 10 U.S.C..., AND DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Electronic storage media. RETRIEVABILITY: By...

75 FR 13090 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-18

... proposed action will be effective without further notice on April 19, 2010 unless comments are received... activities. Categories of records in the system: Individual's name, duty title, grade, Social Security Number... the system: Storage: Electronic storage media. Retrievability: By name, last 8 digits of the Common...

Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland.

PubMed

Snowden, Austyn; Kolb, Hildegard

2017-05-01

To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Naturalistic prospective repeated-measures mixed-methods approach. Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically. © 2016 John Wiley & Sons Ltd.

Toward an integrated computerized patient record.

PubMed

Dole, T R; Luberti, A A

2000-04-01

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

Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

PubMed Central

Hefner, Jennifer; Robbins, Julie; Huerta, Timothy R.

2013-01-01

Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success. PMID:24228257

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.

Are We Ready for Another Change? Digital Signatures Can Change How We Handle the Academic Record

ERIC Educational Resources Information Center

Black, Thomas C.; Mohr, John

2004-01-01

In this electronic age, where information is digital and service is virtual, the registrar profession is changing rapidly to keep up with increasing standards and expectations. EDI and now XML standards enable system-to-system exchanges of academic records information. While many of the registrar's profession display student academic records under…

77 FR 46551 - Office of Privacy, Records, and Disclosure; Privacy Act of 1974, as Amended

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-03

... its intent to create the SIGAR system of records titled, SIGAR-11: Social Media Records, and SIGAR-12: Internal Electronic Collaboration Tools. The Social Media system will assist SIGAR by providing new ways to... SIGAR Intranet and social media tools within the Internet. DATES: Comments must be received no later...

12 CFR 1204.4 - How will FHFA respond to my Privacy Act request?

Code of Federal Regulations, 2010 CFR

2010-01-01

... records it owns or controls. You can find descriptions of FHFA systems of records on its Web site at http... Web site. A description of the systems of records also is available in the “Privacy Act Issuances... libraries or electronically at the Government Printing Office Web site at: http://www.gpoaccess.gov...

Electronic health record - public health (EHR-PH) system prototype for interoperability in 21st century healthcare systems.

PubMed

Orlova, Anna O; Dunnagan, Mark; Finitzo, Terese; Higgins, Michael; Watkins, Todd; Tien, Allen; Beales, Steven

2005-01-01

Information exchange, enabled by computable interoperability, is the key to many of the initiatives underway including the development of Regional Health Information Exchanges, Regional Health Information Organizations, and the National Health Information Network. These initiatives must include public health as a full partner in the emerging transformation of our nation's healthcare system through the adoption and use of information technology. An electronic health record - public health (EHR-PH)system prototype was developed to demonstrate the feasibility of electronic data transfer from a health care provider, i.e. hospital or ambulatory care settings, to multiple customized public health systems which include a Newborn Metabolic Screening Registry, a Newborn Hearing Screening Registry, an Immunization Registry and a Communicable Disease Registry, using HL7 messaging standards. Our EHR-PH system prototype can be considered a distributed EHR-based RHIE/RHIO model - a principal element for a potential technical architecture for a NHIN.

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.

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

PubMed Central

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

2015-01-01

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

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…

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…

Using an Educational Electronic Documentation System to Help Nursing Students Accurately Identify Nursing Diagnoses

ERIC Educational Resources Information Center

Pobocik, Tamara J.

2013-01-01

The use of technology and electronic medical records in healthcare has exponentially increased. This quantitative research project used a pretest/posttest design, and reviewed how an educational electronic documentation system helped nursing students to identify the accurate related to statement of the nursing diagnosis for the patient in the case…

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 in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.

Development of an electronic claim system based on an integrated electronic health record platform to guarantee interoperability.

PubMed

Kim, Hwa Sun; Cho, Hune; Lee, In Keun

2011-06-01

We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

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

PubMed

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

2017-11-30

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

36 CFR 1222.28 - What are the series level recordkeeping requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

... RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS Agency Recordkeeping... systems adequately document agency policies, transactions, and activities, each program must develop... phone calls, meetings, instant messages, and electronic mail exchanges that include substantive...

36 CFR 1222.28 - What are the series level recordkeeping requirements?

Code of Federal Regulations, 2011 CFR

2011-07-01

... RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS Agency Recordkeeping... systems adequately document agency policies, transactions, and activities, each program must develop... phone calls, meetings, instant messages, and electronic mail exchanges that include substantive...

36 CFR 1222.28 - What are the series level recordkeeping requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

... RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS Agency Recordkeeping... systems adequately document agency policies, transactions, and activities, each program must develop... phone calls, meetings, instant messages, and electronic mail exchanges that include substantive...

Security Techniques for the Electronic Health Records.

PubMed

Kruse, Clemens Scott; Smith, Brenna; Vanderlinden, Hannah; Nealand, Alexandra

2017-08-01

The privacy of patients and the security of their information is the most imperative barrier to entry when considering the adoption of electronic health records in the healthcare industry. Considering current legal regulations, this review seeks to analyze and discuss prominent security techniques for healthcare organizations seeking to adopt a secure electronic health records system. Additionally, the researchers sought to establish a foundation for further research for security in the healthcare industry. The researchers utilized the Texas State University Library to gain access to three online databases: PubMed (MEDLINE), CINAHL, and ProQuest Nursing and Allied Health Source. These sources were used to conduct searches on literature concerning security of electronic health records containing several inclusion and exclusion criteria. Researchers collected and analyzed 25 journals and reviews discussing security of electronic health records, 20 of which mentioned specific security methods and techniques. The most frequently mentioned security measures and techniques are categorized into three themes: administrative, physical, and technical safeguards. The sensitive nature of the information contained within electronic health records has prompted the need for advanced security techniques that are able to put these worries at ease. It is imperative for security techniques to cover the vast threats that are present across the three pillars of healthcare.

Auditing The Completeness and Legibility of Computerized Radiological Request Forms.

PubMed

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

2017-11-04

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

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

PubMed

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

2015-05-01

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

Off-line compatible electronic cash method and system

DOEpatents

Kravitz, D.W.; Gemmell, P.S.; Brickell, E.F.

1998-11-03

An off-line electronic cash system having an electronic coin, a bank B, a payee S, and a user U with an account at the bank B as well as a user password z{sub u,i}, has a method for performing an electronic cash transfer. An electronic coin is withdrawn from the bank B by the user U and an electronic record of the electronic coin is stored by the bank B. The coin is paid to the payee S by the user U. The payee S deposits the coin with the bank B. A determination is made that the coin is spent and the record of the coin is deleted by the bank B. A further deposit of the same coin after the record is deleted is determined. Additionally, a determination is made which user U originally withdrew the coin after deleting the record. To perform these operations a key pair is generated by the user, including public and secret signature keys. The public signature key along with a user password z{sub u,i} and a withdrawal amount are sent to the bank B by the user U. In response, the bank B sends a coin to the user U signed by the secret key of the bank indicating the value of the coin and the public key of the user U. The payee S transmits a challenge counter to the user U prior to receiving the coin. 16 figs.

Off-line compatible electronic cash method and system

DOEpatents

Kravitz, David W.; Gemmell, Peter S.; Brickell, Ernest F.

1998-01-01

An off-line electronic cash system having an electronic coin, a bank B, a payee S, and a user U with an account at the bank B as well as a user password z.sub.u,i, has a method for performing an electronic cash transfer. An electronic coin is withdrawn from the bank B by the user U and an electronic record of the electronic coin is stored by the bank B. The coin is paid to the payee S by the user U. The payee S deposits the coin with the bank B. A determination is made that the coin is spent and the record of the coin is deleted by the bank B. A further deposit of the same coin after the record is deleted is determined. Additionally, a determination is made which user U originally withdrew the coin after deleting the record. To perform these operations a key pair is generated by the user, including public and secret signature keys. The public signature key along with a user password z.sub.u,i and a withdrawal amount are sent to the bank B by the user U. In response, the bank B sends a coin to the user U signed by the secret key of the bankindicating the value of the coin and the public key of the user U. The payee S transmits a challenge counter to the user U prior to receiving the coin.

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…

75 FR 8296 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-24

... Service Title: Electronic Animal Disease Reporting System. OMB Control Number: 0583-0139. Summary of..., establishments that slaughter meat, poultry, exotic animals, and rabbits are required to maintain certain records...'s electronic Animal Disease Reporting System (eADRS), establishments report (by shift) slaughter...

Electronic Data Interchange: Using Technology to Exchange Transcripts.

ERIC Educational Resources Information Center

Stewart, John T.

1994-01-01

Describes the Florida Automated System for Transferring Educational Records (FASTER) project, which permits the electronic exchange of student transcripts; uses of similar electronic data interchange (EDI) programs in other states; and the national SPEEDE/ExPRESS project, which uses a standard format for transferring electronic transcripts.…

Visualization of CDA laboratory reports and long term trends as a possible EHR application for patients and physicians.

PubMed

Obenaus, Manuel; Burgsteiner, Harald

2014-01-01

To increase the patient's acceptance of electronic health records and understanding for their laboratory findings a web application was developed which presents all parameters and possible deviations of standard values in a clear way and visualizes the time based trend of all recorded parameters graphically. Documents corresponding to the Clinical document architecture (CDA) R2 laboratory reports standard and a rapid prototyping framework called Groovy on Grails were used. This work shows, that it is possible to create a useful, standards based tool for patients and physicians with comparatively few resources - an application that could be in similar form a part of an electronic Health Record (EHR) system like the Austrian electronic Health Record (ELGA).

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

PubMed

Lium, Jan Tore; Faxvaag, Arild

2006-01-01

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

75 FR 8731 - Privacy Act of 1974, as Amended; Revisions to the Existing System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-25

... existing system of records. SUMMARY: The Department of the Interior (DOI) is issuing public notice of its... systems subject to the Privacy Act of 1974 (5 U.S.C. 552a). DOI-71, ``Electronic FOIA Tracking System and... Solicitor network in the Department of the Interior (DOI), Washington, DC 20240. SYSTEM MANAGER AND ADDRESS...

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. Recording errors were greater in dairy (9.6%) than in meat (1.9%) ewes. Data uploading errors only occurred in M (4.9%). In experiment 3, 120 dairy and 120 meat ewes were weighed using M and AU systems. In both flocks, mean BW recording and data uploading times, as well as overall BW recording time (0.63 ± 0.02 and 0.25 ± 0.01 min/ewe, respectively) were greater in M than in AU, and uploading errors only occurred in M (8.8%). In conclusion, HHR and PDA systems were time-effective for performance recording, both saving time and improving data accuracy. Working load and time for ewe identification were faster in HHR but it did not affect the performance recording time. The PDA was the fastest device for data download. Further research will evaluate the costs of implementing e-ID for performance recording and other uses in sheep farms. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

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

Kildea, John; Hijal, Tarek

We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

78 FR 54946 - Privacy Act; System of Records: Digital Outreach and Communications, State-79

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

.... Only members of the public who choose to interact with the Department through a social media outlet or... social media outlet or other electronic means including by submitting feedback, requesting more... RECORDS IN THE SYSTEM: The system may contain information passed through a social media site to facilitate...

75 FR 43498 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-26

... effective without further notice on August 25, 2010 unless comments are received which result in a contrary.... Categories of records in the system: Name, last four digits of the Social Security Number (SSN), date of... system: Storage: Electronic storage media. Retrievability: Last name, first name and/or last four digits...

77 FR 13574 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-07

... electronic storage media. Retrievability: Individual's name and last four of Social Security Number (SSN... commuting to and from work. Categories of records in the system: Name, last four of Social Security Number... contain the full name of the individual and last four of Social Security Number (SSN). The system manager...

Instant availability of patient records, but diminished availability of patient information: A multi-method study of GP's use of electronic patient records

PubMed Central

Christensen, Tom; Grimsmo, Anders

2008-01-01

Background In spite of succesful adoption of electronic patient records (EPR) by Norwegian GPs, what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized. We wanted to study primary care physicians' use of electronic patient record (EPR) systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship. Methods A combined qualitative and quantitative study that uses data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care. Results The overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study. Conclusion Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians. PMID:18373858

Applications of Electronic Health Information in Public Health: Uses, Opportunities & Barriers

PubMed Central

Tomines, Alan; Readhead, Heather; Readhead, Adam; Teutsch, Steven

2013-01-01

Electronic health information systems can reshape the practice of public health including public health surveillance, disease and injury investigation and control, decision making, quality assurance, and policy development. While these opportunities are potentially transformative, and the federal program for the Meaningful Use (MU) of electronic health records (EHRs) has included important public health components, significant barriers remain. Unlike incentives in the clinical care system, scant funding is available to public health departments to develop the necessary information infrastructure and workforce capacity to capitalize on EHRs, personal health records, or Big Data. Current EHR systems are primarily built to serve clinical systems and practice rather than being structured for public health use. In addition, there are policy issues concerning how broadly the data can be used by public health officials. As these issues are resolved and workable solutions emerge, they should yield a more efficient and effective public health system. PMID:25848571

Electronic recording and reporting system for tuberculosis in China: experience and opportunities

PubMed Central

Huang, Fei; Cheng, ShiMing; Du, Xin; Chen, Wei; Scano, Fabio; Falzon, Dennis; Wang, Lixia

2014-01-01

Tuberculosis (TB) surveillance in China is organized through a nationwide network of about 3200 hospitals and health facilities. In 2005, an electronic Tuberculosis Information Management System (TBIMS) started to be phased in to replace paper recording. The TBIMS collects key information on TB cases notified in TB care facilities, and exchanges real-time data with the Infectious Disease Reporting System, which covers the country’s 37 notifiable diseases. The system is accessible to authorized users at every level of the TB network through a password-protected website. By 2009 the TBIMS achieved nationwide coverage. Completeness of data on patient bacteriological end points improved remarkably over time. Data on about a million active TB cases, including drug-resistant TB, are included each year. The sheer scale of the data handling and the intricate functions that the China TBIMS performs makes it stand apart from the electronic information systems for TB adopted in other countries. PMID:24326537

Nurses' perceptions of e-portfolio use for on-the-job training in Taiwan.

PubMed

Tsai, Pei-Rong; Lee, Ting-Ting; Lin, Hung-Ru; Lee-Hsieh, Jane; Mills, Mary Etta

2015-01-01

Electronic portfolios can be used to record user performance and achievements. Currently, clinical learning systems and in-service education systems lack integration of nurses' clinical performance records with their education or training outcomes. For nurses with less than 2 years' work experience (nursing postgraduate year), use of an electronic portfolio is essential. This study aimed to assess the requirements of using electronic portfolios in continuing nursing education for clinical practices. Fifteen nurses were recruited using a qualitative purposive sampling approach between April 2013 and May 2013. After obtaining participants' consent, data were collected in a conference room of the study hospital by one-on-one semistructured in-depth interviews. Through data analyses, the following five main themes related to electronic learning portfolios were identified: instant access to in-service education information, computerized nursing postgraduate year training manual, diversity of system functions and interface designs, need for sufficient computers, and protection of personal documents. Because electronic portfolios are beginning to be used in clinical settings, a well-designed education information system not only can meet the needs of nurses but also can facilitate their learning progress.

Design of digital voice storage and playback system

NASA Astrophysics Data System (ADS)

Tang, Chao

2018-03-01

Based on STC89C52 chip, this paper presents a single chip microcomputer minimum system, which is used to realize the logic control of digital speech storage and playback system. Compared with the traditional tape voice recording system, the system has advantages of small size, low power consumption, The effective solution of traditional voice recording system is limited in the use of electronic and information processing.

30 CFR 75.800-4 - Testing, examination, and maintenance of circuit breakers; record.

Code of Federal Regulations, 2011 CFR

2011-07-01

... mine. (b) Record security. These records shall be made in a secure book that is not susceptible to alteration or electronically in a computer system so as to be secure and not susceptible to alteration. (c...

30 CFR 75.800-4 - Testing, examination, and maintenance of circuit breakers; record.

Code of Federal Regulations, 2012 CFR

2012-07-01

... mine. (b) Record security. These records shall be made in a secure book that is not susceptible to alteration or electronically in a computer system so as to be secure and not susceptible to alteration. (c...

30 CFR 75.800-4 - Testing, examination, and maintenance of circuit breakers; record.

Code of Federal Regulations, 2014 CFR

2014-07-01

... mine. (b) Record security. These records shall be made in a secure book that is not susceptible to alteration or electronically in a computer system so as to be secure and not susceptible to alteration. (c...

30 CFR 75.800-4 - Testing, examination, and maintenance of circuit breakers; record.

Code of Federal Regulations, 2013 CFR

2013-07-01

... mine. (b) Record security. These records shall be made in a secure book that is not susceptible to alteration or electronically in a computer system so as to be secure and not susceptible to alteration. (c...

75 FR 74019 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-30

... storage media. Retrievability: Information is retrieved by individual's name, Social Security Number (SSN... ``Records include individual's name, Social Security Number (SSN); employee identification number....'' * * * * * Storage: Delete entry and replace with ``Paper records in file folders and electronic storage media...

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

PubMed

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

2014-05-01

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

75 FR 33789 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

... be effective without further notice on July 15, 2010 unless comments are received which result in a... of records in the system: Storage: Paper files folders and electronic storage media. Retrievability... categories: Individual, social workers, rehabilitation counselors, and/or health care personnel. Exemptions...

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

PubMed

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

2015-08-01

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

Building a portable data and information interoperability infrastructure-framework for a standard Taiwan Electronic Medical Record Template.

PubMed

Jian, Wen-Shan; Hsu, Chien-Yeh; Hao, Te-Hui; Wen, Hsyien-Chia; Hsu, Min-Huei; Lee, Yen-Liang; Li, Yu-Chuan; Chang, Polun

2007-11-01

Traditional electronic health record (EHR) data are produced from various hospital information systems. They could not have existed independently without an information system until the incarnation of XML technology. The interoperability of a healthcare system can be divided into two dimensions: functional interoperability and semantic interoperability. Currently, no single EHR standard exists that provides complete EHR interoperability. In order to establish a national EHR standard, we developed a set of local EHR templates. The Taiwan Electronic Medical Record Template (TMT) is a standard that aims to achieve semantic interoperability in EHR exchanges nationally. The TMT architecture is basically composed of forms, components, sections, and elements. Data stored in the elements which can be referenced by the code set, data type, and narrative block. The TMT was established with the following requirements in mind: (1) transformable to international standards; (2) having a minimal impact on the existing healthcare system; (3) easy to implement and deploy, and (4) compliant with Taiwan's current laws and regulations. The TMT provides a basis for building a portable, interoperable information infrastructure for EHR exchange in Taiwan.

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.

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

PubMed

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

2014-09-01

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

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…

Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory.

PubMed

Scantlebury, Arabella; Sheard, Laura; Watt, Ian; Cairns, Paul; Wright, John; Adamson, Joy

2017-01-07

To explore the benefits, barriers and disadvantages of implementing an electronic record system (ERS). The extent that the system has become 'normalised' into routine practice was also explored. Qualitative semi-structured interviews were conducted with 19 members of NHS staff who represented a variety of staff groups (doctors, midwives of different grades, health care assistants) and wards within a maternity unit at a NHS teaching hospital. Interviews were conducted during the first year of the phased implementation of ERS and were analysed thematically. The four mechanisms of Normalisation Process Theory (NPT) (coherence, cognitive participation, collective action and reflexive monitoring) were adapted for use within the study and provided a theoretical framework to interpret the study's findings. Coherence (participants' understanding of why the ERS has been implemented) was mixed - whilst those involved in ERS implementation anticipated advantages such as improved access to information; the majority were unclear why the ERS was introduced. Participants' willingness to engage with and invest time into the ERS (cognitive participation) depended on the amount of training and support they received and their willingness to change from paper to electronic records. Collective action (the extent the ERS was used) may be influenced by whether participants perceived there to be benefits associated with the system. Whilst some individuals reported benefits such as improved legibility of records, others felt benefits were yet to emerge. The parallel use of paper and the lack of integration of electronic systems within and between the trust and other healthcare organisations hindered ERS use. When appraising the ERS (reflexive monitoring) participants perceived the system to negatively impact the patient-clinician relationship, time and patient safety. Despite expectations that the ERS would have a number of advantages, its implementation was perceived to have a range of disadvantages and only a limited number of 'clinical benefits'. The study highlights the complexity of implementing electronic systems and the associated longevity before they can become 'embedded' into routine practice. Through the identification of barriers to the employment of electronic systems this process could be streamlined with the avoidance of any potential detriment to clinical services.

76 FR 64115 - Privacy Act of 1974; Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

...-leaf binders or file folders, and in electronic media, including NASA's Ethics Program Tracking System... documents, electronic media, micrographic media, photographs, or motion pictures film, and various medical....; General Accounting Office's General Policies/Procedures and Communications Manual, Chapter 7; Treasury...

IMPLEMENTING AND AUDITING ELECTRONIC RECORDKEEPING SYSTEMS USED IN SCIENTIFIC RESEARCH AND DEVELOPMENT

EPA Science Inventory

Electronic recordkeeping is increasingly replacing hadwritten records in the course of "normal business." As this trend continues, it is important that organizations develop and implement electronic recordkeeping policies and procedures. This is especially true for Research and...

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

PubMed

Hwang, Min-A; Kwak, In Ja

2015-01-01

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

Final Environmental Impact Statement for Proposed Barry M. Goldwater Range East Range Enhancements (Including First and Second Record of Decision)

DTIC Science & Technology

2010-10-01

modernization has occurred during the last decade, much of the current training infrastructure (including physical and electronic simulations of targets and...delivered air-to-groWld weapons (including precision- guidance systems and stand-off [i.e., long-range] capabilities), electronic sensing and... electronically score pilot performance and record it for post-mission replay. The STA will consist of 640 acres, of which up to 400 acres will be developed

Fundamental Components For The Realization of a Federated Integrated Electronic Health Record Environment

DTIC Science & Technology

2001-10-25

for the deployment of the I- EHR at a regional level, and a large number of CISs systems have been supported, ranging from primary health care and...1 of 4 Abstract - The Integrated Electronic Health Record (I- EHR ) is a term used to describe the whole set of information that exists in...electronic form and is related to the personal health of an indi- vidual. Any approach towards I- EHR focuses on the needs of professionals or citizens who

Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems

PubMed Central

2012-01-01

Background Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT. Methods Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. Results 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. Conclusions Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT. Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care. PMID:22230095

78 FR 39012 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-28

... inquiry by a federal, state, or local government entity or professional licensing authority, in accordance... the Commission's office and electronic records located on the Commission's Server. RETRIEVABILITY...

Electronic patient record and archive of records in Cardio.net system for telecardiology.

PubMed

Sierdziński, Janusz; Karpiński, Grzegorz

2003-01-01

In modern medicine the well structured patient data set, fast access to it and reporting capability become an important question. With the dynamic development of information technology (IT) such question is solved via building electronic patient record (EPR) archives. We then obtain fast access to patient data, diagnostic and treatment protocols etc. It results in more efficient, better and cheaper treatment. The aim of the work was to design a uniform Electronic Patient Record, implemented in cardio.net system for telecardiology allowing the co-operation among regional hospitals and reference centers. It includes questionnaires for demographic data and questionnaires supporting doctor's work (initial diagnosis, final diagnosis, history and physical, ECG at the discharge, applied treatment, additional tests, drugs, daily and periodical reports). The browser is implemented in EPR archive to facilitate data retrieval. Several tools for creating EPR and EPR archive were used such as: XML, PHP, Java Script and MySQL. The separate question is the security of data on WWW server. The security is ensured via Security Socket Layer (SSL) protocols and other tools. EPR in Cardio.net system is a module enabling the co-work of many physicians and the communication among different medical centers.

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

PubMed

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

2009-07-01

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

IT and security considerations for online clinical records.

PubMed

Williams, Patricia A H

2010-03-01

E-health and the national electronic medical record are on our doorstep. As an integral part of the healthcare system, dentistry needs to get on board with this national initiative. How prepared is the dental profession for this? How can a culture of online clinical records be promoted and what protocols and infrastructure exist for this to occur? The lack of government restriction means that dentistry should be taking full advantage of what is possible. The benefits and barriers to adoption of online records will be presented to provide a frame of reference for the next major shift in electronic communication.

A Novel Electronic Data Collection System for Large-Scale Surveys of Neglected Tropical Diseases

PubMed Central

King, Jonathan D.; Buolamwini, Joy; Cromwell, Elizabeth A.; Panfel, Andrew; Teferi, Tesfaye; Zerihun, Mulat; Melak, Berhanu; Watson, Jessica; Tadesse, Zerihun; Vienneau, Danielle; Ngondi, Jeremiah; Utzinger, Jürg; Odermatt, Peter; Emerson, Paul M.

2013-01-01

Background Large cross-sectional household surveys are common for measuring indicators of neglected tropical disease control programs. As an alternative to standard paper-based data collection, we utilized novel paperless technology to collect data electronically from over 12,000 households in Ethiopia. Methodology We conducted a needs assessment to design an Android-based electronic data collection and management system. We then evaluated the system by reporting results of a pilot trial and from comparisons of two, large-scale surveys; one with traditional paper questionnaires and the other with tablet computers, including accuracy, person-time days, and costs incurred. Principle Findings The electronic data collection system met core functions in household surveys and overcame constraints identified in the needs assessment. Pilot data recorders took 264 (standard deviation (SD) 152 sec) and 260 sec (SD 122 sec) per person registered to complete household surveys using paper and tablets, respectively (P = 0.77). Data recorders felt a lack of connection with the interviewee during the first days using electronic devices, but preferred to collect data electronically in future surveys. Electronic data collection saved time by giving results immediately, obviating the need for double data entry and cross-correcting. The proportion of identified data entry errors in disease classification did not differ between the two data collection methods. Geographic coordinates collected using the tablets were more accurate than coordinates transcribed on a paper form. Costs of the equipment required for electronic data collection was approximately the same cost incurred for data entry of questionnaires, whereas repeated use of the electronic equipment may increase cost savings. Conclusions/Significance Conducting a needs assessment and pilot testing allowed the design to specifically match the functionality required for surveys. Electronic data collection using an Android-based technology was suitable for a large-scale health survey, saved time, provided more accurate geo-coordinates, and was preferred by recorders over standard paper-based questionnaires. PMID:24066147

Brief Report: Databases in the Asia-Pacific Region: The Potential for a Distributed Network Approach.

PubMed

Lai, Edward Chia-Cheng; Man, Kenneth K C; Chaiyakunapruk, Nathorn; Cheng, Ching-Lan; Chien, Hsu-Chih; Chui, Celine S L; Dilokthornsakul, Piyameth; Hardy, N Chantelle; Hsieh, Cheng-Yang; Hsu, Chung Y; Kubota, Kiyoshi; Lin, Tzu-Chieh; Liu, Yanfang; Park, Byung Joo; Pratt, Nicole; Roughead, Elizabeth E; Shin, Ju-Young; Watcharathanakij, Sawaeng; Wen, Jin; Wong, Ian C K; Yang, Yea-Huei Kao; Zhang, Yinghong; Setoguchi, Soko

2015-11-01

This study describes the availability and characteristics of databases in Asian-Pacific countries and assesses the feasibility of a distributed network approach in the region. A web-based survey was conducted among investigators using healthcare databases in the Asia-Pacific countries. Potential survey participants were identified through the Asian Pharmacoepidemiology Network. Investigators from a total of 11 databases participated in the survey. Database sources included four nationwide claims databases from Japan, South Korea, and Taiwan; two nationwide electronic health records from Hong Kong and Singapore; a regional electronic health record from western China; two electronic health records from Thailand; and cancer and stroke registries from Taiwan. We identified 11 databases with capabilities for distributed network approaches. Many country-specific coding systems and terminologies have been already converted to international coding systems. The harmonization of health expenditure data is a major obstacle for future investigations attempting to evaluate issues related to medical costs.

Mobile health platform for pressure ulcer monitoring with electronic health record integration.

PubMed

Rodrigues, Joel J P C; Pedro, Luís M C C; Vardasca, Tomé; de la Torre-Díez, Isabel; Martins, Henrique M G

2013-12-01

Pressure ulcers frequently occur in patients with limited mobility, for example, people with advanced age and patients wearing casts or prostheses. Mobile information communication technologies can help implement ulcer care protocols and the monitoring of patients with high risk, thus preventing or improving these conditions. This article presents a mobile pressure ulcer monitoring platform (mULCER), which helps control a patient's ulcer status during all stages of treatment. Beside its stand-alone version, it can be integrated with electronic health record systems as mULCER synchronizes ulcer data with any electronic health record system using HL7 standards. It serves as a tool to integrate nursing care among hospital departments and institutions. mULCER was experimented with in different mobile devices such as LG Optimus One P500, Samsung Galaxy Tab, HTC Magic, Samsung Galaxy S, and Samsung Galaxy i5700, taking into account the user's experience of different screen sizes and processing characteristics.

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

PubMed

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

2006-01-01

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

36 CFR § 1222.28 - What are the series level recordkeeping requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

... AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS Agency... series and systems adequately document agency policies, transactions, and activities, each program must... documentation of phone calls, meetings, instant messages, and electronic mail exchanges that include substantive...

75 FR 6005 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... proposed action will be effective on March 8, 2010 unless comments are received that would result in a...: Name, Social Security Numbers (SSN), rank/grade, service number, marital status, the number of..., retaining and disposing of records in the system: Storage: Electronic storage media. Retrievability...

78 FR 73509 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

... entering into CENTCOM's theater of operation. DATES: This proposed action will be effective on January 7... files and Manpower Authorization files, including name; grade/rank; Social Security Number (SSN); DoD ID..., retaining, and disposing of records in the system: Storage: Electronic storage media. Retrievability...

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

PubMed

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

2003-01-01

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

[Automated anesthesia record systems].

PubMed

Heinrichs, W; Mönk, S; Eberle, B

1997-07-01

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

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

PubMed

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

2012-08-01

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

[Support of the nursing process through electronic nursing documentation systems (UEPD) – Initial validation of an instrument].

PubMed

Hediger, Hannele; Müller-Staub, Maria; Petry, Heidi

2016-01-01

Electronic nursing documentation systems, with standardized nursing terminology, are IT-based systems for recording the nursing processes. These systems have the potential to improve the documentation of the nursing process and to support nurses in care delivery. This article describes the development and initial validation of an instrument (known by its German acronym UEPD) to measure the subjectively-perceived benefits of an electronic nursing documentation system in care delivery. The validity of the UEPD was examined by means of an evaluation study carried out in an acute care hospital (n = 94 nurses) in German-speaking Switzerland. Construct validity was analyzed by principal components analysis. Initial references of validity of the UEPD could be verified. The analysis showed a stable four factor model (FS = 0.89) scoring in 25 items. All factors loaded ≥ 0.50 and the scales demonstrated high internal consistency (Cronbach's α = 0.73 – 0.90). Principal component analysis revealed four dimensions of support: establishing nursing diagnosis and goals; recording a case history/an assessment and documenting the nursing process; implementation and evaluation as well as information exchange. Further testing with larger control samples and with different electronic documentation systems are needed. Another potential direction would be to employ the UEPD in a comparison of various electronic documentation systems.

LabTrove: A Lightweight, Web Based, Laboratory “Blog” as a Route towards a Marked Up Record of Work in a Bioscience Research Laboratory

PubMed Central

Milsted, Andrew J.; Hale, Jennifer R.; Frey, Jeremy G.; Neylon, Cameron

2013-01-01

Background The electronic laboratory notebook (ELN) has the potential to replace the paper notebook with a marked-up digital record that can be searched and shared. However, it is a challenge to achieve these benefits without losing the usability and flexibility of traditional paper notebooks. We investigate a blog-based platform that addresses the issues associated with the development of a flexible system for recording scientific research. Methodology/Principal Findings We chose a blog-based approach with the journal characteristics of traditional notebooks in mind, recognizing the potential for linking together procedures, materials, samples, observations, data, and analysis reports. We implemented the LabTrove blog system as a server process written in PHP, using a MySQL database to persist posts and other research objects. We incorporated a metadata framework that is both extensible and flexible while promoting consistency and structure where appropriate. Our experience thus far is that LabTrove is capable of providing a successful electronic laboratory recording system. Conclusions/Significance LabTrove implements a one-item one-post system, which enables us to uniquely identify each element of the research record, such as data, samples, and protocols. This unique association between a post and a research element affords advantages for monitoring the use of materials and samples and for inspecting research processes. The combination of the one-item one-post system, consistent metadata, and full-text search provides us with a much more effective record than a paper notebook. The LabTrove approach provides a route towards reconciling the tensions and challenges that lie ahead in working towards the long-term goals for ELNs. LabTrove, an electronic laboratory notebook (ELN) system from the Smart Research Framework, based on a blog-type framework with full access control, facilitates the scientific experimental recording requirements for reproducibility, reuse, repurposing, and redeployment. PMID:23935832

LabTrove: a lightweight, web based, laboratory "blog" as a route towards a marked up record of work in a bioscience research laboratory.

PubMed

Milsted, Andrew J; Hale, Jennifer R; Frey, Jeremy G; Neylon, Cameron

2013-01-01

The electronic laboratory notebook (ELN) has the potential to replace the paper notebook with a marked-up digital record that can be searched and shared. However, it is a challenge to achieve these benefits without losing the usability and flexibility of traditional paper notebooks. We investigate a blog-based platform that addresses the issues associated with the development of a flexible system for recording scientific research. We chose a blog-based approach with the journal characteristics of traditional notebooks in mind, recognizing the potential for linking together procedures, materials, samples, observations, data, and analysis reports. We implemented the LabTrove blog system as a server process written in PHP, using a MySQL database to persist posts and other research objects. We incorporated a metadata framework that is both extensible and flexible while promoting consistency and structure where appropriate. Our experience thus far is that LabTrove is capable of providing a successful electronic laboratory recording system. LabTrove implements a one-item one-post system, which enables us to uniquely identify each element of the research record, such as data, samples, and protocols. This unique association between a post and a research element affords advantages for monitoring the use of materials and samples and for inspecting research processes. The combination of the one-item one-post system, consistent metadata, and full-text search provides us with a much more effective record than a paper notebook. The LabTrove approach provides a route towards reconciling the tensions and challenges that lie ahead in working towards the long-term goals for ELNs. LabTrove, an electronic laboratory notebook (ELN) system from the Smart Research Framework, based on a blog-type framework with full access control, facilitates the scientific experimental recording requirements for reproducibility, reuse, repurposing, and redeployment.

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

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

PubMed Central

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

2002-01-01

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

32 CFR Appendix E to Part 310 - Sample of New or Altered System of Records Notice in Federal Register Format

Code of Federal Regulations, 2010 CFR

2010-07-01

.... DATES: The changes will be effective on (insert date thirty days after publication in the Federal... the system: Storage: Records are maintained on electronic storage media and paper. Retrievability... changes to the system notice. DATES: This action will be effective without further notice on (insert date...

77 FR 44642 - Privacy Act of 1974; Department of Homeland Security U.S. Customs and Border Protection-DHS/CBP...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-30

... 1974; Department of Homeland Security U.S. Customs and Border Protection-DHS/CBP-009 Electronic System for Travel Authorization (ESTA) System of Records AGENCY: Privacy Office, Department of Homeland Security. ACTION: Notice of Privacy Act system of records. SUMMARY: In accordance with the Privacy Act of...

From a paper-based to an electronic registry in physiotherapy.

PubMed

Buyl, Ronald; Nyssen, Marc

2008-01-01

During the past decade the healthcare industry has evolved from paper-based storage of clinical data into the digital era. Electronic healthcare records play a crucial role to meet the growing need for integrated data-storage and data communication. In this context a new law was issued in Belgium on December 7th, 2005, which requires physiotherapists (but also nurses and speech therapists) to keep an electronic version of the registry. This (electronic) registry contains all physiotherapeutic acts, starting from January 1, 2007. Up until that day, a paper version of the registry had to be created every month.This article describes the development of an electronic version of the registry that not only meets all legal constraints, but also enables to verify the traceability and inalterability of the generated documents, by means of SHA-256 codes. One of the major concerns of the process was that the rationale behind the electronic registry would conform well to the common practice of the physiotherapist. Therefore we opted for a periodic recording of a standardized "image" of the controllable data, in the patient database of the software-system, into the XML registry messages. The proposed XSLT schema can also form a basis for the development of tools that can be used by the controlling authorities. Hopefully the electronic registry for physiotherapists will be a first step towards the future development of a fully integrated electronic physiotherapy record.By means of a certification procedure for the software systems, we succeeded in developing a user friendly system that enables end-users that use a quality labeled software package, to automatically produce all the legally necessary documents concerning the registry. Moreover, we hope that this development will be an incentive for non-users to start working in an electronic way.

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

PubMed

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

2011-01-01

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

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

PubMed Central

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

2011-01-01

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

A qualitative study of Canada's experience with the implementation of electronic health information technology.

PubMed

Rozenblum, Ronen; Jang, Yeona; Zimlichman, Eyal; Salzberg, Claudia; Tamblyn, Melissa; Buckeridge, David; Forster, Alan; Bates, David W; Tamblyn, Robyn

2011-03-22

In 2001, Canada Health Infoway unveiled a plan to implement a national system of interoperable electronic health records. This government-funded corporation introduced a novel model for interprovincial/territorial collaboration to establish core aspects of a national framework. Despite this $1.6 billion initiative, Canada continues to lag behind other Western countries in adopting electronic health records. We conducted a study to identify the success of different aspects of the Canadian plan and ways to improve the adoption of electronic health records. We used a case study approach to assess the 10-year history of Canada's e-health plan. National reports and documents were reviewed, and structured interviews were conducted with 29 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Using grounded theory, we analyzed transcripts of the interviews to identify themes and their relationships. Key stakeholders identified funding, national standards, patient registries and digital imaging as important achievements of the e-health plan. Lack of an e-health policy, inadequate involvement of clinicians, failure to establish a business case for using electronic health records, a focus on national rather than regional interoperability, and inflexibility in approach were seen as barriers to adoption of the plan. To accelerate adoption of electronic health records and timely return on investment, an e-health policy needs to be tightly aligned with the major strategic directions of health care reform. Adoption needs to be actively fostered through a bottom-up, clinical-needs-first approach, a national policy for investment in electronic health records, and financial incentives based on patient outcomes that can be achieved with electronic health records.

A qualitative study of Canada’s experience with the implementation of electronic health information technology

PubMed Central

Rozenblum, Ronen; Jang, Yeona; Zimlichman, Eyal; Salzberg, Claudia; Tamblyn, Melissa; Buckeridge, David; Forster, Alan; Bates, David W.; Tamblyn, Robyn

2011-01-01

Background In 2001, Canada Health Infoway unveiled a plan to implement a national system of interoperable electronic health records. This government-funded corporation introduced a novel model for interprovincial/territorial collaboration to establish core aspects of a national framework. Despite this $1.6 billion initiative, Canada continues to lag behind other Western countries in adopting electronic health records. We conducted a study to identify the success of different aspects of the Canadian plan and ways to improve the adoption of electronic health records. Methods We used a case study approach to assess the 10-year history of Canada’s e-health plan. National reports and documents were reviewed, and structured interviews were conducted with 29 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Using grounded theory, we analyzed transcripts of the interviews to identify themes and their relationships. Results Key stakeholders identified funding, national standards, patient registries and digital imaging as important achievements of the e-health plan. Lack of an e-health policy, inadequate involvement of clinicians, failure to establish a business case for using electronic health records, a focus on national rather than regional interoperability, and inflexibility in approach were seen as barriers to adoption of the plan. Interpretation To accelerate adoption of electronic health records and timely return on investment, an e-health policy needs to be tightly aligned with the major strategic directions of health care reform. Adoption needs to be actively fostered through a bottom-up, clinical-needs-first approach, a national policy for investment in electronic health records, and financial incentives based on patient outcomes that can be achieved with electronic health records. PMID:21343262

SU-E-T-240: Design and Implement of An Electronic Records Function for Treatment Plan Checked Meeting

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

Wu, Q

Purpose: To replace the paper records, we designed an electronic records function for plan checked meeting in our in-house developed radiotherapy information management system(RTIMS). Methods: Since 2007, the RTIMS has been developed on a database and web service of Apache+PHP+MySQL, and almost all computers and smartphones could access the RTIMS through IE browser, to input, search, count, and print the data. In 2012, we also established an radiation therapy case conference multi-media system(RTCCMMS) based on Windows Remote Desktop feature. Since 2013, we have carried out the treatment plan checked meeting of the physics division in every afternoon for about halfmore » an hour. In 2014, we designed an electronic records function, which includes a meeting information record and a checked plan record. And the meeting record includes the following items: meeting date, name, place, length, status, attendee, content, etc. The plan record includes the followings: meeting date, meeting name, patient ID, gender, age, patient name, course, plan, purpose, position, technique, CTsim type, plan type, primary doctor, other doctor, primary physicist, other physicist, difficulty, quality, score, opinion, status, note, etc. Results: In the past year, the electronic meeting records function has been successfully developed and implemented in the division, and it could be accessed from an smartphone. Almost all items have the corresponding pull-down menu selection, and each option would try to intelligently inherit default value from the former record or other form. According to the items, we could do big data mining to the input data. It also has both Chinese and English two versions. Conclusion: It was demonstrated to be user-friendly and was proven to significantly improve the clinical efficiency and quality of treatment plan. Since the RTIMS is an in-house developed system, more functions can be added or modified to further enhance its potentials in research and clinical practice. Project supported by the National Natural Science Foundation of China (Grant No.81101694)« less

The Lean Acquisition Strategy Behind the DOD’s 2015 Electronic Health Record System

DTIC Science & Technology

2016-09-01

4  F.  RESEARCH BENEFITS ..........................................................................5  G.  ORGANIZATION OF RESEARCH ...program, four key managers were interviewed. This intent of this section is to show the research organization and procedures. 1. Subjects Each... ORGANIZATION OF RESEARCH Chapter II provides a history of the electronic health record in the United States, a review of the DOD’s previous EHR acquisitions

75 FR 2118 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-14

...: Maintained on computer and electronic storage media. RETRIEVABILITY: Retrieved by name and Social Security... proposed action will be effective without further notice on February 16, 2010 unless comments are received....'' * * * * * CATEGORIES OF RECORDS IN THE SYSTEM: Delete entry and replace with ``Name, Social Security Number (SSN...

75 FR 14141 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-24

... electronic storage media. RETRIEVABILITY: Individual's name, Social Security Number (SSN), or date of birth... action will be effective without further notice on April 23, 2010 unless comments are received that would... facilities. CATEGORIES OF RECORDS IN THE SYSTEM: Subject individual's full name, Social Security Number (SSN...

76 FR 16739 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

...: Electronic storage media and paper records. Retrievability: Retrieved by individual's name and Social... individual's full name, Social Security Number (SSN), address and be signed. The system manager may require an original signature or a notarized signature as a means of proving the identity of the individual...

75 FR 13293 - Agency Information Collection Activities: Arrival and Departure Record

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-19

...), the Form I-94W (Nonimmigrant Visa Waiver Arrival/Departure), and the Electronic System for Travel... Act (Pub. L.104-13). Your comments should address one of the following four points: (1) Evaluate..., Nonimmigrant Visa Waiver Arrival/Departure, Electronic System for Travel Authorization (ESTA) OMB Number: 1651...

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…

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

PubMed

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

2007-10-01

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

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

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

PubMed

Caine, Kelly; Hanania, Rima

2013-01-01

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

Incorporating Pharmacogenomics into Health Information Technology, Electronic Health Record and Decision Support System: An Overview.

PubMed

Alanazi, Abdullah

2017-02-01

As the adoption of information technology in healthcare is rising, the potentiality of moving Pharmacogenomics from benchside to bedside is aggravated. This paper reviews the current status of Pharmacogenomics (PGx) information and the attempts for incorporating them into the Electronic Health Record (EHR) system through Decision Support Systems (DSSs). Rigorous review strategies of PGx information and providing context-relevant recommendations in form of action plan- dose adjustment, lab tests rather than just information- would be ideal for making clinical recommendations out of PGx information. Lastly, realistic projections of what pharmacogenomics can provide is another important aspect in incorporating Pharmacogenomics into health information technology.

Health Information Systems.

PubMed

Sirintrapun, S Joseph; Artz, David R

2015-06-01

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

An Electronic Health Record - Public Health (EHR-PH) System Prototype for Interoperability in 21st Century Healthcare Systems

PubMed Central

Orlova, Anna O.; Dunnagan, Mark; Finitzo, Terese; Higgins, Michael; Watkins, Todd; Tien, Allen; Beales, Steven

2005-01-01

Information exchange, enabled by computable interoperability, is the key to many of the initiatives underway including the development of Regional Health Information Exchanges, Regional Health Information Organizations, and the National Health Information Network. These initiatives must include public health as a full partner in the emerging transformation of our nation’s healthcare system through the adoption and use of information technology. An electronic health record - public health (EHR-PH) system prototype was developed to demonstrate the feasibility of electronic data transfer from a health care provider, i.e. hospital or ambulatory care settings, to multiple customized public health systems which include a Newborn Metabolic Screening Registry, a Newborn Hearing Screening Registry, an Immunization Registry and a Communicable Disease Registry, using HL7 messaging standards. Our EHR-PH system prototype can be considered a distributed EHR-based RHIE/RHIO model - a principal element for a potential technical architecture for a NHIN. PMID:16779105

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

PubMed

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

2016-11-01

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

PA partnership publishes IT recommendations.

PubMed

2007-07-01

Long-term goal is a statewide regional health information system. Partners assert that electronic health information exchange will promote safety and efficiency. Eventually, all citizens in the state will have complete personal health records available electronically.

78 FR 73515 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

... service personnel. DATES: This proposed action will be effective on January 6, 2014 unless comments are... concerning the appointment of trustees for mentally incompetent service members. Records include name, Social... electronic storage media.'' Retrievability: Delete entry and replace with ``Name, record number, year of...

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

PubMed

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

2008-01-01

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

A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.

PubMed

Adelman, Jason S; Berger, Matthew A; Rai, Amisha; Galanter, William L; Lambert, Bruce L; Schiff, Gordon D; Vawdrey, David K; Green, Robert A; Salmasian, Hojjat; Koppel, Ross; Schechter, Clyde B; Applebaum, Jo R; Southern, William N

2017-09-01

To reduce the risk of wrong-patient errors, safety experts recommend limiting the number of patient records providers can open at once in electronic health records (EHRs). However, it is unknown whether health care organizations follow this recommendation or what rationales drive their decisions. To address this gap, we conducted an electronic survey via 2 national listservs. Among 167 inpatient and outpatient study facilities using EHR systems designed to open multiple records at once, 44.3% were configured to allow ≥3 records open at once (unrestricted), 38.3% allowed only 1 record open (restricted), and 17.4% allowed 2 records open (hedged). Decision-making centered on efforts to balance safety and efficiency, but there was disagreement among organizations about how to achieve that balance. Results demonstrate no consensus on the number of records to be allowed open at once in EHRs. Rigorous studies are needed to determine the optimal number of records that balances safety and efficiency. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Using Human Factors Methods to Design a New Interface for an Electronic Medical Record

PubMed Central

Saleem, Jason J.; Patterson, Emily S.; Militello, Laura; Asch, Steven M.; Doebbeling, Bradley N.; Render, Marta L.

2007-01-01

The Veterans Health Administration (VHA) is a leader in development and use of electronic patient records and clinical decision support. The VHA is currently reengineering a somewhat dated platform for its Computerized Patient Record System (CPRS). This process affords a unique opportunity to implement major changes to the current design and function of the system. We report on two human factors studies designed to provide input and guidance during this reengineering process. One study involved a card sort to better understand how providers tend to cognitively organize clinical data, and how that understanding can help guide interface design. The other involved a simulation to assess the impact of redesign modifications on computerized clinical reminders, a form of clinical decision support in the CPRS, on the learnability of the system for first-time users. PMID:18693914

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

PubMed

Carter, Evelene M; Potts, Henry W W

2014-04-04

To investigate whether factors can be identified that significantly affect hospital length of stay from those available in an electronic patient record system, using primary total knee replacements as an example. To investigate whether a model can be produced to predict the length of stay based on these factors to help resource planning and patient expectations on their length of stay. Data were extracted from the electronic patient record system for discharges from primary total knee operations from January 2007 to December 2011 (n=2,130) at one UK hospital and analysed for their effect on length of stay using Mann-Whitney and Kruskal-Wallis tests for discrete data and Spearman's correlation coefficient for continuous data. Models for predicting length of stay for primary total knee replacements were tested using the Poisson regression and the negative binomial modelling techniques. Factors found to have a significant effect on length of stay were age, gender, consultant, discharge destination, deprivation and ethnicity. Applying a negative binomial model to these variables was successful. The model predicted the length of stay of those patients who stayed 4-6 days (~50% of admissions) with 75% accuracy within 2 days (model data). Overall, the model predicted the total days stayed over 5 years to be only 88 days more than actual, a 6.9% uplift (test data). Valuable information can be found about length of stay from the analysis of variables easily extracted from an electronic patient record system. Models can be successfully created to help improve resource planning and from which a simple decision support system can be produced to help patient expectation on their length of stay.

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

PubMed

Robles, Jane

2009-01-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

PubMed

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

2018-05-09

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

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.

"Teaching Case": ComprehensiveCare and the Re-Adoption of an Electronic Health Records System: Preparing for a Successful Adoption after a Failed Attempt

ERIC Educational Resources Information Center

Gomillion, David L.

2017-01-01

After a prior failed adoption, ComprehensiveCare plans for a second attempt in adopting Electronic Health Records. The owner-physicians on the board of directors have replaced the administrator due in part to the missteps of the prior adoption. William Shoemaker, the new administrator, must grapple with several important decisions to provide the…

Amalgamation of management information system into anaesthesiology practice: A boon for the modern anaesthesiologists

PubMed Central

Bajwa, Sukhminder Jit Singh

2014-01-01

Over the years, traditional anaesthesia record keeping system has been the backbone of anaesthesiology ever since its introduction in the 1890s by Dr. Harvey Cushing and Dr. Ernest A. Codman. Besides providing the important information regarding patients’ vital physiologic parameters, paper records had been a reliable source for various clinical research activities. The introduction of electronic monitoring gadgets and electronic record keeping systems has revolutionised the anaesthesiology practice to a large extent. Recently, the introduction of anaesthesia information management system (AIMS), which incorporates all the features of monitoring gadgets, such as electronic storage of large accurate data, quality assurance in anaesthesia, enhancing patient safety, ensuring legal protection, improved billing services and effecting an organisational change, is almost a revolution in modern-day anaesthesiology practice. The clinical research activities that are responsible for taking anaesthesiology discipline to higher peaks have also been boosted by the amalgamation of AIMS, enabling multicenter studies and sharing of clinical data. Barring few concerns in its installation, cost factors and functional aspects, the future of AIMS seems to be bright and will definitely prove to be a boon for modern-day anaesthesiology practice. PMID:24963173

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.

The value of structured data elements from electronic health records for identifying subjects for primary care clinical trials.

PubMed

Ateya, Mohammad B; Delaney, Brendan C; Speedie, Stuart M

2016-01-11

An increasing number of clinical trials are conducted in primary care settings. Making better use of existing data in the electronic health records to identify eligible subjects can improve efficiency of such studies. Our study aims to quantify the proportion of eligibility criteria that can be addressed with data in electronic health records and to compare the content of eligibility criteria in primary care with previous work. Eligibility criteria were extracted from primary care studies downloaded from the UK Clinical Research Network Study Portfolio. Criteria were broken into elemental statements. Two expert independent raters classified each statement based on whether or not structured data items in the electronic health record can be used to determine if the statement was true for a specific patient. Disagreements in classification were discussed until 100 % agreement was reached. Statements were also classified based on content and the percentages of each category were compared to two similar studies reported in the literature. Eligibility criteria were retrieved from 228 studies and decomposed into 2619 criteria elemental statements. 74 % of the criteria elemental statements were considered likely associated with structured data in an electronic health record. 79 % of the studies had at least 60 % of their criteria statements addressable with structured data likely to be present in an electronic health record. Based on clinical content, most frequent categories were: "disease, symptom, and sign", "therapy or surgery", and "medication" (36 %, 13 %, and 10 % of total criteria statements respectively). We also identified new criteria categories related to provider and caregiver attributes (2.6 % and 1 % of total criteria statements respectively). Electronic health records readily contain much of the data needed to assess patients' eligibility for clinical trials enrollment. Eligibility criteria content categories identified by our study can be incorporated as data elements in electronic health records to facilitate their integration with clinical trial management systems.

Development and implementation of an integrated EHR for Homecare Service: a South American experience.

PubMed

Aguilera Díaz, Jerónimo; Arias, Antonio Eduardo; Budalich, Cintia Mabel; Benítez, Sonia Elizabeth; López, Gastón; Borbolla, Damián; Plazzotta, Fernando; Luna, Daniel; de Quirós, Fernán González Bernaldo

2010-01-01

This paper describes the development and implementation of a web based electronic health record for the Homecare Service program in the Hospital Italiano de Buenos Aires. It reviews the process of the integration of the new electronic health record to the hospital information system, allowing physicians to access the clinical data repository from their Pc's at home and with the capability of consulting past and present history of the patient health care, order, tests, and referrals with others professionals trough the new Electronic Health Record. We also discuss how workflow processes were changed and improved for the physicians, nurses, and administrative personnel of the Homecare Services and the educational methods used to improve acceptance and adoption of these new technologies. We also briefly describe the validation of physicians and their field work with electronic signatures.

32 CFR 505.2 - General provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Family members often use the deceased individual's Social Security Number (SSN) for federal entitlements... established, based on the media (e.g., paper, electronic) involved, to ensure the security of the records and... Social Security Numbers. (1) Only those records covered by a Privacy Act system of records notice may be...

32 CFR 505.2 - General provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Family members often use the deceased individual's Social Security Number (SSN) for federal entitlements... established, based on the media (e.g., paper, electronic) involved, to ensure the security of the records and... Social Security Numbers. (1) Only those records covered by a Privacy Act system of records notice may be...

78 FR 77719 - Privacy Act of 1974; Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

..., leave and payroll deduction information; and job performance and personnel actions. For civil servants... report previous job injuries to worker's compensation organizations; (6) for person to notify in an...-electronic records are secured in locked rooms or files. RETENTION AND DISPOSAL: Records are maintained in...

NATIONAL HEALTH & ENVIRONMENTAL EFFECTS RESEARCH LABORATORY BEGINS IMPLEMENTATION OF AN ELECTRONIC SCIENTIFIC DATA MANAGEMENT SYSTEM

EPA Science Inventory

Data and records management have changed greatly as a result of progress in computer technology, but many organizations, including the US EPA's National Records Management Program (NRMP) and the U.S. National Archives and Records Administration (NARA), still struggle to escape th...

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.

75 FR 29818 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

... computers used with the particular project are available to authorized personnel only. Records on... Research and Development Project Records--VA'' (34VA12) as set forth in the Federal Register 40 FR 38095... include electronic or other databases containing research information developed during a research project...

An automated system for the study of ionospheric spatial structures

NASA Astrophysics Data System (ADS)

Belinskaya, I. V.; Boitman, O. N.; Vugmeister, B. O.; Vyborova, V. M.; Zakharov, V. N.; Laptev, V. A.; Mamchenko, M. S.; Potemkin, A. A.; Radionov, V. V.

The system is designed for the study of the vertical distribution of electron density and the parameters of medium-scale ionospheric irregularities over the sounding site as well as the reconstruction of the spatial distribution of electron density within the range of up to 300 km from the sounding location. The system comprises an active central station as well as passive companion stations. The central station is equipped with the digital ionosonde ``Basis'', the measuring-and-computing complex IVK-2, and the receiver-recorder PRK-3M. The companion stations are equipped with receivers-recorders PRK-3. The automated comlex software system includes 14 subsystems. Data transfer between them is effected using magnetic disk data sets. The system is operated in both ionogram mode and Doppler shift and angle-of-arrival mode. Using data obtained in these two modes, the reconstruction of the spatial distribution of electron density in the region is carried out. Reconstruction is checked for accuracy using data from companion stations.

Clinical Summarization Capabilities of Commercially-available and Internally-developed Electronic Health Records

PubMed Central

Laxmisan, A.; McCoy, A.B.; Wright, A.; Sittig, D.F.

2012-01-01

Objective Clinical summarization, the process by which relevant patient information is electronically summarized and presented at the point of care, is of increasing importance given the increasing volume of clinical data in electronic health record systems (EHRs). There is a paucity of research on electronic clinical summarization, including the capabilities of currently available EHR systems. Methods We compared different aspects of general clinical summary screens used in twelve different EHR systems using a previously described conceptual model: AORTIS (Aggregation, Organization, Reduction, Interpretation and Synthesis). Results We found a wide variation in the EHRs’ summarization capabilities: all systems were capable of simple aggregation and organization of limited clinical content, but only one demonstrated an ability to synthesize information from the data. Conclusion Improvement of the clinical summary screen functionality for currently available EHRs is necessary. Further research should identify strategies and methods for creating easy to use, well-designed clinical summary screens that aggregate, organize and reduce all pertinent patient information as well as provide clinical interpretations and synthesis as required. PMID:22468161

Comparison of manual versus semiautomatic milk recording systems in dairy goats.

PubMed

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

2008-04-01

A total of 24 Murciano-Granadina dairy goats in early-midlactation were used to compare the labor time and data collection efficiency of using manual (M) vs. semiautomated (SA) systems for milk recording. Goats were milked once daily in a 2 x 12 parallel platform, with 6 milking units on each side. The M system used visual identification (ID) by large plastic ear tags, on-paper data recording, and data manually uploaded to a computer. The SA system used electronic ID, automatic ID, manual data recording on reader keyboard, and automatic data uploading to computer by Bluetooth connection. Data were collected for groups of 2 x 12 goats for 15 test days of each system during a period of 70 d. Time data were converted to a decimal scale. No difference in milk recording time between M and SA (1.32 +/- 0.03 and 1.34 +/- 0.03 min/goat, respectively) was observed. Time needed for transferring data to the computer was greater for M when compared with SA (0.20 +/- 0.01 and 0.05 +/- 0.01 min/goat). Overall milk recording time was greater in M than in SA (1.52 +/- 0.04 vs. 1.39 +/- 0.04 min/goat), the latter decreasing with operator training. Time for transferring milk recording data to the computer was 4.81 +/- 0.34 and 1.09 +/- 0.10 min for M and SA groups of 24 goats, respectively, but only increased by 0.19 min in SA for each additional 24 goats. No difference in errors of data acquisition was detected between M and SA systems during milk recording (0.6%), but an additional 1.1% error was found in the M system during data uploading. Predicted differences between M and SA increased with the number of goats processed on the test-day. Reduction in labor time cost ranged from euro0.5 to 12.9 (US$0.7 to 17.4) per milk recording, according to number of goats from 24 to 480 goats and accounted for 40% of the electronic ID costs. In conclusion, electronic ID was more efficient for labor costs and resulted in fewer data errors, the benefit being greater with trained operators and larger goat herds.

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

PubMed

England, S P

1993-11-01

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

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

PubMed

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

1996-01-01

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

Sonar Locator Systems

NASA Technical Reports Server (NTRS)

1985-01-01

An underwater locator device called a Pinger is attached to an airplane's flight recorder for recovery in case of a crash. Burnett Electronics Pinger Model 512 resulted from a Burnett Electronics Laboratory, Inc./Langley Research Center contract for development of a search system for underwater mines. The Pinger's battery-powered transmitter is activated when immersed in water, and sends multidirectional signals for up to 500 hours. When a surface receiver picks up the signal, a diver can retrieve the pinger and the attached airplane flight recorder. Other pingers are used to track whales, mark underwater discoveries and assist oil drilling vessels.

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

PubMed

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

2011-08-01

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

Managing the life cycle of electronic clinical documents.

PubMed

Payne, Thomas H; Graham, Gail

2006-01-01

To develop a model of the life cycle of clinical documents from inception to use in a person's medical record, including workflow requirements from clinical practice, local policy, and regulation. We propose a model for the life cycle of clinical documents as a framework for research on documentation within electronic medical record (EMR) systems. Our proposed model includes three axes: the stages of the document, the roles of those involved with the document, and the actions those involved may take on the document at each stage. The model includes the rules to describe who (in what role) can perform what actions on the document, and at what stages they can perform them. Rules are derived from needs of clinicians, and requirements of hospital bylaws and regulators. Our model encompasses current practices for paper medical records and workflow in some EMR systems. Commercial EMR systems include methods for implementing document workflow rules. Workflow rules that are part of this model mirror functionality in the Department of Veterans Affairs (VA) EMR system where the Authorization/ Subscription Utility permits document life cycle rules to be written in English-like fashion. Creating a model of the life cycle of clinical documents serves as a framework for discussion of document workflow, how rules governing workflow can be implemented in EMR systems, and future research of electronic documentation.

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

PubMed Central

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

2016-01-01

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

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

PubMed

Steidl, Matthew; Zimmern, Philippe

2013-01-01

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

The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network.

PubMed

Benthin, Cody; Pannu, Sonal; Khan, Akram; Gong, Michelle

2016-10-01

The nature, variability, and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently used in acute care settings for clinical care or research is unknown. To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network. We surveyed investigators at 38 institutions involved in the National Institutes of Health-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis. Thirty sites completed the survey (79% response rate). All sites used electronic health record systems. Epic Systems was used at 56% of sites; the others used alternate commercially available vendors or homegrown systems. Respondents at 57% of sites represented in this survey used e-alerts. All but 1 of these 17 sites used an e-alert for early detection of sepsis-related syndromes, and 35% used an e-alert for pneumonia. E-alerts were triggered by abnormal laboratory values (37%), vital signs (37%), or radiology reports (15%) and were used about equally for clinical decision support and research. Only 59% of sites with e-alerts have evaluated them either for accuracy or for validity. A majority of the research network sites participating in this survey use e-alerts for early notification of potential threats to hospitalized patients; however, there was significant variability in the nature of e-alerts between institutions. Use of one common electronic health record vendor at more than half of the participating sites suggests that it may be possible to standardize e-alerts across multiple sites in research networks, particularly among sites using the same medical record platform.

Progress along developmental tracks for electronic health records implementation in the United States

PubMed Central

Hollar, David W

2009-01-01

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States. PMID:19291284

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

PubMed

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

1997-01-01

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

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

PubMed

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

2013-01-01

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

Ambulatory EHR functionality: a comparison of functionality lists.

PubMed

Drury, Barbara M

2006-01-01

There is a proliferation of lists intended to define and clarify the functionality of an ambulatory electronic health record system. These lists come from both private and public entities and vary in terminology, granularity, usability, and comprehensiveness. For example, functionality regarding a problem list includes the following possible definitions: * "Create and maintain patient-specific problem lists," from the HL7 Electronic Health Record Draft Standard for Trial Use. * "Provide a flexible mechanism for retrieval of encounter information that can be organized by diagnosis, problem, problem type," from the Bureau of Primary Health Care. * "The system shall associate encounters, orders, medications and notes with one or more problems," from the Certification Commission on Health Information Technology. * "Displays dates of problems on problem list," from COPIC Insurance Co. * "Shall automatically close acute problems using an automated algorithm," from the Physicians Foundations HIT Subcommittee. This article will compare the attributes of these five electronic health record functionality lists and their usefulness to different audiences-clinicians, application developers and payers.

Negotiating Access to Health Information to Promote Students' Health.

PubMed

Radis, Molly E; Updegrove, Stephen C; Somsel, Anne; Crowley, Angela A

2016-04-01

Access to student health information, such as immunizations, screenings, and care plans for chronic conditions, is essential for school nurses to fulfill their role in promoting students' health. School nurses typically encounter barriers to accessing health records and spend many hours attempting to retrieve health information. As a result, nurses' time is poorly utilized and students may suffer adverse outcomes including delayed school entry. In response to this pressing public health issue, a school medical advisor and director of school nurses in a local health department successfully negotiated access for school nurses to three health record systems: a state immunization tracking system, an electronic lead surveillance program, and an electronic health record system. This negotiation process is presented within a framework of the Theory of Diffusion of Innovation and provides a strategy for other school nurses seeking access to student health information. © The Author(s) 2015.

Better informed in clinical practice - a brief overview of dental informatics.

PubMed

Reynolds, P A; Harper, J; Dunne, S

2008-03-22

Uptake of dental informatics has been hampered by technical and user issues. Innovative systems have been developed, but usability issues have affected many. Advances in technology and artificial intelligence are now producing clinically useful systems, although issues still remain with adapting computer interfaces to the dental practice working environment. A dental electronic health record has become a priority in many countries, including the UK. However, experience shows that any dental electronic health record (EHR) system cannot be subordinate to, or a subset of, a medical record. Such a future dental EHR is likely to incorporate integrated care pathways. Future best dental practice will increasingly depend on computer-based support tools, although disagreement remains about the effectiveness of current support tools. Over the longer term, future dental informatics tools will incorporate dynamic, online evidence-based medicine (EBM) tools, and promise more adaptive, patient-focused and efficient dental care with educational advantages in training.

Systems Architecture for a Nationwide Healthcare System.

PubMed

Abin, Jorge; Nemeth, Horacio; Friedmann, Ignacio

2015-01-01

From a national level to give Internet technology support, the Nationwide Integrated Healthcare System in Uruguay requires a model of Information Systems Architecture. This system has multiple healthcare providers (public and private), and a strong component of supplementary services. Thus, the data processing system should have an architecture that considers this fact, while integrating the central services provided by the Ministry of Public Health. The national electronic health record, as well as other related data processing systems, should be based on this architecture. The architecture model described here conceptualizes a federated framework of electronic health record systems, according to the IHE affinity model, HL7 standards, local standards on interoperability and security, as well as technical advice provided by AGESIC. It is the outcome of the research done by AGESIC and Systems Integration Laboratory (LINS) on the development and use of the e-Government Platform since 2008, as well as the research done by the team Salud.uy since 2013.

The economics of integrated electronic medical record systems.

PubMed

Chismar, William G; Thomas, Sean M

2004-01-01

The decision to adopt electronic medical record systems in private practices is usually based on factors specific to the practice--the cost, cost and timesaving, and impact on quality of care. As evident by the low adoption rates, providers have not found these evaluations compelling. However, it is recognized that the widespread adoption of EMR systems would greatly benefit the health care system as a whole. One explanation for the lack of adoption is that there is a misalignment of the costs and benefits of EMR systems across the health care system. In this paper we present an economic model of the adoption of EMR systems that explicitly represents the distribution of costs and benefits across stakeholders (physicians, hospitals, insurers, etc.). We discuss incentive systems for balancing the costs and benefits and, thus, promoting the faster adoption of EMR systems. Finally, we describe our plan to extend the model and to use real-world data to evaluate our model.

Expansion of electronic health record-based screening, prevention, and management of diabetes in New York City.

PubMed

Albu, Jeanine; Sohler, Nancy; Matti-Orozco, Brenda; Sill, Jordan; Baxter, Daniel; Burke, Gary; Young, Edwin

2013-01-01

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community-clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre-post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care.

Challenges of self-reported medical conditions and electronic medical records among members of a large military cohort

PubMed Central

Smith, Besa; Chu, Laura K; Smith, Tyler C; Amoroso, Paul J; Boyko, Edward J; Hooper, Tomoko I; Gackstetter, Gary D; Ryan, Margaret AK

2008-01-01

Background Self-reported medical history data are frequently used in epidemiological studies. Self-reported diagnoses may differ from medical record diagnoses due to poor patient-clinician communication, self-diagnosis in the absence of a satisfactory explanation for symptoms, or the "health literacy" of the patient. Methods The US Department of Defense military health system offers a unique opportunity to evaluate electronic medical records with near complete ascertainment while on active duty. This study compared 38 self-reported medical conditions to electronic medical record data in a large population-based US military cohort. The objective of this study was to better understand challenges and strengths in self-reporting of medical conditions. Results Using positive and negative agreement statistics for less-prevalent conditions, near-perfect negative agreement and moderate positive agreement were found for the 38 diagnoses. Conclusion This report highlights the challenges of using self-reported medical data and electronic medical records data, but illustrates that agreement between the two data sources increases with increased surveillance period of medical records. Self-reported medical data may be sufficient for ruling out history of a particular condition whereas prevalence studies may be best served by using an objective measure of medical conditions found in electronic healthcare records. Defining medical conditions from multiple sources in large, long-term prospective cohorts will reinforce the value of the study, particularly during the initial years when prevalence for many conditions may still be low. PMID:18644098

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. Domain 3: In the inter-enterprise domain, the EPR must allow for patient information to be exchanged with external providers including referring doctors, laboratories, and other hospitals via community health information networks (CHINs). Sunnybrook will prioritize the development of first domain functionality within the corporate constraints imposed by the integrated organization domain. Inter-enterprise computing will be less of a priority until Sunnybrook has developed a critical mass of the electronic patient record internally. The three domain description is a useful model for describing the relationship between the electronic patient record enabling technologies and the Sunnybrook organizational structures. The taskforce has used this model to determine EPR development guidelines and implementation priorities.

The E-health Literacy Demands of Australia's My Health Record: A Heuristic Evaluation of Usability.

PubMed

Walsh, Louisa; Hemsley, Bronwyn; Allan, Meredith; Adams, Natalie; Balandin, Susan; Georgiou, Andrew; Higgins, Isabel; McCarthy, Shaun; Hill, Sophie

2017-01-01

My Health Record is Australia's electronic personal health record system, which was introduced in July 2012. As of August 2017, approximately 21 percent of Australia's total population was registered to use My Health Record. Internationally, usability issues have been shown to negatively influence the uptake and use of electronic health record systems, and this scenario may particularly affect people who have low e-health literacy. It is likely that usability issues are negatively affecting the uptake and use of My Health Record in Australia. To identify potential e-health literacy-related usability issues within My Health Record through a heuristic evaluation method. Between September 14 and October 12, 2016, three of the authors conducted a heuristic evaluation of the two consumer-facing components of My Health Record-the information website and the electronic health record itself. These two components were evaluated against two sets of heuristics-the Health Literacy Online checklist and the Monkman Heuristics. The Health Literacy Online checklist and Monkman Heuristics are evidence-based checklists of web design elements with a focus on design for audiences with low health literacy. During this heuristic evaluation, the investigators individually navigated through the consumer-facing components of My Health Record, recording instances where the My Health Record did not conform to the checklist criteria. After the individual evaluations were completed, the investigators conferred and aggregated their results. From this process, a list of usability violations was constructed. When evaluated against the Health Literacy Online Checklist, the information website demonstrated violations in 12 of 35 criteria, and the electronic health record demonstrated violations in 16 of 35 criteria. When evaluated against the Monkman Heuristics, the information website demonstrated violations in 7 of 11 criteria, and the electronic health record demonstrated violations in 9 of 11 criteria. The identified violations included usability issues with the reading levels used within My Health Record, the graphic design elements, the layout of web pages, and a lack of images and audiovisual tools to support learning. Other important usability issues included a lack of translated resources, difficulty using accessibility tools, and complexity of the registration processes. My Health Record is an important piece of technology that has the potential to facilitate better communication between consumers and their health providers. However, this heuristic evaluation demonstrated that many usability-related elements of My Health Record cater poorly to users at risk of having low e-health literacy. Usability issues have been identified as an important barrier to use of personal health records internationally, and the findings of this heuristic evaluation demonstrate that usability issues may be substantial barriers to the uptake and use of My Health Record.

Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use.

PubMed

Dixon, Brian E; Colvard, Cyril; Tierney, William M

2014-06-24

Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

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

PubMed

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

2017-11-01

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

EMR management system for patient pulse data.

PubMed

Lee, Junyoung

2012-10-01

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

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

PubMed Central

2017-01-01

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

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

PubMed

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

2015-01-01

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

Linking guidelines to Electronic Health Record design for improved chronic disease management.

PubMed

Barretto, Sistine A; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and workflow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR.

Linking Guidelines to Electronic Health Record Design for Improved Chronic Disease Management

PubMed Central

Barretto, Sistine A.; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and work-flow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR. PMID:14728135

76 FR 71067 - Privacy Act of 1974; Notification To Delete and Create a New System of Records, “HUD/FHA Lender...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-16

... Electronic Assessment Portal AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notification to... or officers of financial institutions seeking approval or approved to originate, service, or hold FHA..., 2011. Jerry E. Williams, Chief Information Officer. HUD/SF01.2502 SYSTEM NAME: Lender Electronic...

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.…

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…

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

PubMed Central

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

2016-01-01

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

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

PubMed

Lynott, Michelle H; Kooienga, Sarah A; Stewart, Valerie T

2012-01-01

The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient-provider communication. Many studies have focused on communication in the examination room. Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians. One researcher participated in and observed three health systems' EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient-provider communication. Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR. The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes.

A shared electronic health record: lessons from the coalface.

PubMed

Silvester, Brett V; Carr, Simon J

2009-06-01

A shared electronic health record system has been successfully implemented in Australia by a Division of General Practice in northern Brisbane. The system grew out of coordinated care trials that showed the critical need to share summary patient information, particularly for patients with complex conditions who require the services of a wide range of multisector, multidisciplinary health care professionals. As at 30 April 2008, connected users of the system included 239 GPs from 66 general practices, two major public hospitals, three large private hospitals, 11 allied health and community-based provider organisations and 1108 registered patients. Access data showed a patient's shared record was accessed an average of 15 times over a 12-month period. The success of the Brisbane implementation relied on seven key factors: connectivity, interoperability, change management, clinical leadership, targeted patient involvement, information at the point of care, and governance. The Australian Commission on Safety and Quality in Health Care is currently evaluating the system for its potential to reduce errors relating to inadequate information transfer during clinical handover.

The E-health Literacy Demands of Australia's My Health Record: A Heuristic Evaluation of Usability

PubMed Central

Walsh, Louisa; Hemsley, Bronwyn; Allan, Meredith; Adams, Natalie; Balandin, Susan; Georgiou, Andrew; Higgins, Isabel; McCarthy, Shaun; Hill, Sophie

2017-01-01

Background My Health Record is Australia's electronic personal health record system, which was introduced in July 2012. As of August 2017, approximately 21 percent of Australia's total population was registered to use My Health Record. Internationally, usability issues have been shown to negatively influence the uptake and use of electronic health record systems, and this scenario may particularly affect people who have low e-health literacy. It is likely that usability issues are negatively affecting the uptake and use of My Health Record in Australia. Objective To identify potential e-health literacy–related usability issues within My Health Record through a heuristic evaluation method. Methods Between September 14 and October 12, 2016, three of the authors conducted a heuristic evaluation of the two consumer-facing components of My Health Record—the information website and the electronic health record itself. These two components were evaluated against two sets of heuristics—the Health Literacy Online checklist and the Monkman Heuristics. The Health Literacy Online checklist and Monkman Heuristics are evidence-based checklists of web design elements with a focus on design for audiences with low health literacy. During this heuristic evaluation, the investigators individually navigated through the consumer-facing components of My Health Record, recording instances where the My Health Record did not conform to the checklist criteria. After the individual evaluations were completed, the investigators conferred and aggregated their results. From this process, a list of usability violations was constructed. Results When evaluated against the Health Literacy Online Checklist, the information website demonstrated violations in 12 of 35 criteria, and the electronic health record demonstrated violations in 16 of 35 criteria. When evaluated against the Monkman Heuristics, the information website demonstrated violations in 7 of 11 criteria, and the electronic health record demonstrated violations in 9 of 11 criteria. The identified violations included usability issues with the reading levels used within My Health Record, the graphic design elements, the layout of web pages, and a lack of images and audiovisual tools to support learning. Other important usability issues included a lack of translated resources, difficulty using accessibility tools, and complexity of the registration processes. Conclusion My Health Record is an important piece of technology that has the potential to facilitate better communication between consumers and their health providers. However, this heuristic evaluation demonstrated that many usability-related elements of My Health Record cater poorly to users at risk of having low e-health literacy. Usability issues have been identified as an important barrier to use of personal health records internationally, and the findings of this heuristic evaluation demonstrate that usability issues may be substantial barriers to the uptake and use of My Health Record. PMID:29118683

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

PubMed

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

2017-05-01

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

Definition, structure, content, use and impacts of electronic health records: a review of the research literature.

PubMed

Häyrinen, Kristiina; Saranto, Kaija; Nykänen, Pirkko

2008-05-01

This paper reviews the research literature on electronic health record (EHR) systems. The aim is to find out (1) how electronic health records are defined, (2) how the structure of these records is described, (3) in what contexts EHRs are used, (4) who has access to EHRs, (5) which data components of the EHRs are used and studied, (6) what is the purpose of research in this field, (7) what methods of data collection have been used in the studies reviewed and (8) what are the results of these studies. A systematic review was carried out of the research dealing with the content of EHRs. A literature search was conducted on four electronic databases: Pubmed/Medline, Cinalh, Eval and Cochrane. The concept of EHR comprised a wide range of information systems, from files compiled in single departments to longitudinal collections of patient data. Only very few papers offered descriptions of the structure of EHRs or the terminologies used. EHRs were used in primary, secondary and tertiary care. Data were recorded in EHRs by different groups of health care professionals. Secretarial staff also recorded data from dictation or nurses' or physicians' manual notes. Some information was also recorded by patients themselves; this information is validated by physicians. It is important that the needs and requirements of different users are taken into account in the future development of information systems. Several data components were documented in EHRs: daily charting, medication administration, physical assessment, admission nursing note, nursing care plan, referral, present complaint (e.g. symptoms), past medical history, life style, physical examination, diagnoses, tests, procedures, treatment, medication, discharge, history, diaries, problems, findings and immunization. In the future it will be necessary to incorporate different kinds of standardized instruments, electronic interviews and nursing documentation systems in EHR systems. The aspects of information quality most often explored in the studies reviewed were the completeness and accuracy of different data components. It has been shown in several studies that the use of an information system was conducive to more complete and accurate documentation by health care professionals. The quality of information is particularly important in patient care, but EHRs also provide important information for secondary purposes, such as health policy planning. Studies focusing on the content of EHRs are needed, especially studies of nursing documentation or patient self-documentation. One future research area is to compare the documentation of different health care professionals with the core information about EHRs which has been determined in national health projects. The challenge for ongoing national health record projects around the world is to take into account all the different types of EHRs and the needs and requirements of different health care professionals and consumers in the development of EHRs. A further challenge is the use of international terminologies in order to achieve semantic interoperability.

Television animation store: Recording pictures on a parallel transfer magnetic disc

NASA Astrophysics Data System (ADS)

Durey, A. J.

1984-12-01

The recording and replaying of digital video signals using a computer-type magnetic disc-drive as part of an electronic rostrum camera animation system is described. The system was developed to enable picture sequences to be generated directly as television signals, instead of using cine film. The characteristics of the disc-drive are described together with data processing, error protection and signal synchronization systems, which enable digital television YUV component signals, sampled at 12 MHz, 4 MHz and 4 MHz respectively, to be recorded and replayed in real time.

Surveillance of contrast-media-induced hypersensitivity reactions using signals from an electronic medical recording system.

PubMed

Kim, Min-Hye; Park, Chang-Han; Kim, Duk-In; Kim, Kyung-Mook; Kim, Hui-Kyu; Lim, Kyu-Hyoung; Song, Woo-Jung; Lee, Sang-Min; Kim, Sae-Hoon; Kwon, Hyouk-Soo; Park, Heung-Woo; Yoon, Chang-Jin; Cho, Sang-Heon; Min, Kyung-Up; Kim, You-Young; Chang, Yoon-Seok

2012-03-01

Contrast-media (CM) hypersensitivity is a well-known adverse drug reaction. Surveillance of adverse drug reactions usually depends on spontaneous reports. However, the rate of spontaneous reports is low. Recent progress in information technology enables the electronic search on signals of adverse drug reactions from electronic medical recording (EMR) systems. To analyze the incidence and clinical characteristics of CM hypersensitivity using an EMR-based surveillance system. The surveillance system used signals from standardized terms within the international classification of nursing practice terms that can indicate symptoms of CM hypersensitivity and from the order codes for procedures that used contrast media, antihistamine, and epinephrine. The search strategy was validated by allergists comparing the electronic search strategy versus manually reviewing medical charts over one month. The main study covered for one year period. Detection rate of the electronic search method was 0.9% (7/759), while that of the manual search method was 0.8% (6/759). EMR-based electronic search method was highly efficient: reduced the charts that needed to be reviewed by 96% (28/759). The sensitivity of electronic screening was 66.7%, specificity was 99.6%, and the negative predictive value was 99.7%. CM hypersensitivity reactions were noted in 266 among 12,483 cases (2.1%). Urticaria was the most frequent symptom (74.4%). CT was the most frequent procedure (3.6%) that induced CM hypersensitivity. A surveillance system using EMR may be a useful tool in the study of drug hypersensitivity epidemiology and may be used in an adverse drug reaction alarm system and as a clinical, decision making support system. Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-04-01

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

Wireless, High-Bandwidth Recordings from Non-Human Primate Motor Cortex using a Scalable 16-Ch Implantable Microsystem

PubMed Central

Borton, David A.; Song, Yoon-Kyu; Patterson, William R.; Bull, Christopher W.; Park, Sunmee; Laiwalla, Farah; Donoghue, John P.; Nurmikko, Arto V.

2013-01-01

A multitude of neuroengineering challenges exist today in creating practical, chronic multichannel neural recording systems for primate research and human clinical application. Specifically, a) the persistent wired connections limit patient mobility from the recording system, b) the transfer of high bandwidth signals to external (even distant) electronics normally forces premature data reduction, and c) the chronic susceptibility to infection due to the percutaneous nature of the implants all severely hinder the success of neural prosthetic systems. Here we detail one approach to overcome these limitations: an entirely implantable, wirelessly communicating, integrated neural recording microsystem, dubbed the Brain Implantable Chip (BIC). PMID:19964128

Advanced Technologies in Safe and Efficient Operating Rooms

DTIC Science & Technology

2007-02-01

facilities that deal with trauma. The resulting chaos can be overwhelming, even with some form of electronic health record ( EHR ) system (currently...computers which process this data to deliver more efficient health -related services. The EMR is an essential part of systems like the Traumapod [24...perioperative situational awareness system that captures and records data from various medical devices and provides an integrated display to allow the operating

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

PubMed

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

2012-12-01

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

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

PubMed

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

2005-08-01

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

Integrated information systems for electronic chemotherapy medication administration.

PubMed

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

2011-07-01

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

Safety and fitness electronic records system (SAFER) : user and system requirements document

DOT National Transportation Integrated Search

1996-10-28

The Federal Highway Administration (FHWA) is currently testing and evaluating Intelligent : Transportation Systems (ITS) technologies to enhance the safety and efficiency of interstate and : intrastate commercial vehicle operations. The current focus...

Electronic Health Records: VA and DOD Need to Support Cost and Schedule Claims, Develop Interoperability Plans, and Improve Collaboration

DTIC Science & Technology

2014-02-01

Page 13 GAO-14-302 Electronic Health Records known as the Captain James A. Lovell Federal Health Care Center ( FHCC ). The FHCC is unique in...Healthcare Management System Modernization DOD Department of Defense FHCC Federal Health Care Center FHIE Federal Health Information Exchange GCPR... FHCC and, in accordance with the fiscal year 2010 NDAA, defined the relationship between the two departments for operating the new, integrated

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

PubMed

Brandes, Susan; Wells, Karen; Bandy, Margaret

2013-01-01

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

Changes to Workflow and Process Measures in the PICU During Transition From Semi to Full Electronic Health Record.

PubMed

Salib, Mina; Hoffmann, Raymond G; Dasgupta, Mahua; Zimmerman, Haydee; Hanson, Sheila

2015-10-01

Studies showing the changes in workflow during transition from semi to full electronic medical records are lacking. This objective study is to identify the changes in workflow in the PICU during transition from semi to full electronic health record. Prospective observational study. Children's Hospital of Wisconsin Institutional Review Board waived the need for approval so this study was institutional review board exempt. This study measured clinical workflow variables at a 72-bed PICU during different phases of transition to a full electronic health record, which occurred on November 4, 2012. Phases of electronic health record transition were defined as follows: pre-electronic health record (baseline data prior to transition to full electronic health record), transition phase (3 wk after electronic health record), and stabilization (6 mo after electronic health record). Data were analyzed for the three phases using Mann-Whitney U test with a two-sided p value of less than 0.05 considered significant. Seventy-two bed PICU. All patients in the PICU were included during the study periods. Five hundred and sixty-four patients with 2,355 patient days were evaluated in the three phases. Duration of rounds decreased from a median of 9 minutes per patient pre--electronic health record to 7 minutes per patient post electronic health record. Time to final note decreased from 2.06 days pre--electronic health record to 0.5 days post electronic health record. Time to first medication administration after admission also decreased from 33 minutes pre--electronic health record and 7 minutes post electronic health record. Time to Time to medication reconciliation was significantly higher pre-electronic health record than post electronic health record and percent of medication reconciliation completion was significantly lower pre--electronic health record than post electronic health record and percent of medication reconciliation completion was significantly higher pre--electronic health record than. There was no significant change in time between placement of discharge order and physical transfer from the unit [corrected].changes clinical workflow in a PICU with decreased duration of rounds, time to final note, time to medication administration, and time to medication reconciliation completion. There was no change in the duration from medical to physical transfer.

Use an Electronic Gradebook.

ERIC Educational Resources Information Center

Shalvoy, Mary Lee

1985-01-01

Describes range of options and features in gradebook programs and reviews most popular and readily available software for organizing, calculating, and updating grades: Master Grades, EA Gradebook, Gradeaid, Grader, Graphic Gradebook, Classic Plus Gradekeeping System, Records, Gradecalc, Grade Master, Report Card, Electronic Gradebook for…

Electronic health record use in an affluent region in India: Findings from a survey of Chandigarh hospitals.

PubMed

Powell, Adam C; Ludhar, Jasmine K; Ostrovsky, Yuri

2017-07-01

To characterize the electronic health record (EHR) systems in use in an affluent region of India in order to understand the state-of-the-art within the Indian market. A survey on EHR features was created by combining an instrument developed by the Organisation for International Cooperation and Development and an instrument developed by an American team of researchers. An interviewer directly administered the survey to leaders from hospitals in greater Chandigarh which possessed electronic health information systems. Summary statistics from the survey are reported. 24 hospitals offering multi-specialty inpatient care were identified in greater Chandigarh. 18 of these hospitals had electronic health information systems, 17 of which were interviewed. Of the hospitals with systems, 17 (100%) could access patient demographic information internally, but 12 (71%) could not access vital sign, allergy, or immunization data internally. 11 (65%) of the systems were capable of sharing patient summaries internally, but 13 (76%) could not send electronic referrals internally. Among organizations which have adopted systems, major barriers tend to have been around financial and staff matters. Concerns over interoperability, privacy, and security were infrequently cited as barriers to adoption. EHRs are ubiquitous in at least one region of India. Systems are more likely to have capabilities for intra-organizational information sharing than for inter-organizational information sharing. The availability of EHR data may foster clinical research. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

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

PubMed

Bar-Lev, Shirly

2015-03-01

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

The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems.

PubMed

Sujansky, Walter V; Overhage, J Marc; Chang, Sophia; Frohlich, Jonah; Faus, Samuel A

2009-01-01

Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.

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

PubMed

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

2011-01-01

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

An inventory of publications on electronic medical records revisited.

PubMed

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

2009-01-01

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

Fabrication method of two-photon luminescent organic nano-architectures using electron-beam irradiation

NASA Astrophysics Data System (ADS)

Kamura, Yoshio; Imura, Kohei

2018-06-01

Optical recording on organic thin films with a high spatial resolution is promising for high-density optical memories, optical computing, and security systems. The spatial resolution of the optical recording is limited by the diffraction of light. Electrons can be focused to a nanometer-sized spot, providing the potential for achieving better resolution. In conventional electron-beam lithography, however, optical tuning of the fabricated structures is limited mostly to metals and semiconductors rather than organic materials. In this article, we report a fabrication method of luminescent organic architectures using a focused electron beam. We optimized the fabrication conditions of the electron beam to generate chemical species showing visible photoluminescence via two-photon near-infrared excitations. We utilized this fabrication method to draw nanoscale optical architectures on a polystyrene thin film.

Development, implementation, and evaluation of a hybrid electronic medical record system specifically designed for a developing world surgical service.

PubMed

Laing, G L; Bruce, J L; Skinner, D L; Allorto, N L; Clarke, D L; Aldous, C

2014-06-01

The Pietermaritzburg Metropolitan Trauma Service previously successfully constructed and implemented an electronic surgical registry (ESR). This study reports on our attempts to expand and develop this concept into a multi-functional hybrid electronic medical record (HEMR) system for use in a tertiary level surgical service. This HEMR system was designed to incorporate the function and benefits of an ESR, an electronic medical record (EMR) system, and a clinical decision support system (CDSS). Formal ethical approval to maintain the HEMR system was obtained. Appropriate software was sourced to develop the project. The data model was designed as a relational database. Following the design and construction process, the HEMR file was launched on a secure server. This provided the benefits of access security and automated backups. A systematic training program was implemented for client training. The exercise of data capture was integrated into the process of clinical workflow, taking place at multiple points in time. Data were captured at the times of admission, operative intervention, endoscopic intervention, adverse events (morbidity), and the end of patient care (discharge, transfer, or death). A quarterly audit was performed 3 months after implementation of the HEMR system. The data were extracted and audited to assess their quality. A total of 1,114 patient entries were captured in the system. Compliance rates were in the order of 87-100 %, and client satisfaction rates were high. It is possible to construct and implement a unique, simple, cost-effective HEMR system in a developing world surgical service. This information system is unique in that it combines the discrete functions of an EMR system with an ESR and a CDSS. We identified a number of potential limitations and developed interventions to ameliorate them. This HEMR system provides the necessary platform for ongoing quality improvement programs and clinical research.

Security and privacy of EHR systems--ethical, social and legal requirements.

PubMed

Kluge, Eike-Henner W

2003-01-01

This paper addresses social, ethical and legal concerns about security and privacy that arise in the development of international interoperable health information systems. The paper deals with these concerns under four rubrics: the ethical status of electronic health records, the social and legal embedding of interoperable health information systems, the overall information-requirements healthcare as such, and the role of health information professionals as facilitators. It argues that the concerns that arise can be met if the development of interoperability protocols is guided by the seven basic principles of information ethics that have been enunciated in the IMIA Code of Ethics for Health Information Professionals and that are central to the ethical treatment of electronic health records.

An information extraction framework for cohort identification using electronic health records.

PubMed

Liu, Hongfang; Bielinski, Suzette J; Sohn, Sunghwan; Murphy, Sean; Wagholikar, Kavishwar B; Jonnalagadda, Siddhartha R; Ravikumar, K E; Wu, Stephen T; Kullo, Iftikhar J; Chute, Christopher G

2013-01-01

Information extraction (IE), a natural language processing (NLP) task that automatically extracts structured or semi-structured information from free text, has become popular in the clinical domain for supporting automated systems at point-of-care and enabling secondary use of electronic health records (EHRs) for clinical and translational research. However, a high performance IE system can be very challenging to construct due to the complexity and dynamic nature of human language. In this paper, we report an IE framework for cohort identification using EHRs that is a knowledge-driven framework developed under the Unstructured Information Management Architecture (UIMA). A system to extract specific information can be developed by subject matter experts through expert knowledge engineering of the externalized knowledge resources used in the framework.

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

PubMed

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

2018-06-01

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

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

PubMed

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

2014-12-01

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

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

PubMed

Baus, Adam; Hendryx, Michael; Pollard, Cecil

2012-01-01

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

Optimized Computer Systems for Avionics Applications.

DTIC Science & Technology

1980-02-01

medium. The recording may be photographic ( film ) or electronic (tape, disk, or digital memory). After the recording has been completed at N distinct...data into a domain where the signal components become decorrelated. Another popular intepretation is that the transformation is a mechanism for

Electronic recording and reporting system for tuberculosis in China: experience and opportunities.

PubMed

Huang, Fei; Cheng, ShiMing; Du, Xin; Chen, Wei; Scano, Fabio; Falzon, Dennis; Wang, Lixia

2014-01-01

Tuberculosis (TB) surveillance in China is organized through a nationwide network of about 3200 hospitals and health facilities. In 2005, an electronic Tuberculosis Information Management System (TBIMS) started to be phased in to replace paper recording. The TBIMS collects key information on TB cases notified in TB care facilities, and exchanges real-time data with the Infectious Disease Reporting System, which covers the country's 37 notifiable diseases. The system is accessible to authorized users at every level of the TB network through a password-protected website. By 2009 the TBIMS achieved nationwide coverage. Completeness of data on patient bacteriological end points improved remarkably over time. Data on about a million active TB cases, including drug-resistant TB, are included each year. The sheer scale of the data handling and the intricate functions that the China TBIMS performs makes it stand apart from the electronic information systems for TB adopted in other countries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-24

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Renewal of Advisory Committee on Electronic Records... Records Administration's (NARA) Advisory Committee on Electronic Records Archives. In accordance with... Committee on Electronic Records Archives in NARA's ceiling of discretionary advisory committees. FOR FURTHER...