Bioelectronic neural pixel: Chemical stimulation and electrical sensing at the same site

PubMed Central

Jonsson, Amanda; Inal, Sahika; Uguz, Ilke; Williamson, Adam J.; Kergoat, Loïg; Rivnay, Jonathan; Khodagholy, Dion; Berggren, Magnus; Bernard, Christophe; Malliaras, George G.

2016-01-01

Local control of neuronal activity is central to many therapeutic strategies aiming to treat neurological disorders. Arguably, the best solution would make use of endogenous highly localized and specialized regulatory mechanisms of neuronal activity, and an ideal therapeutic technology should sense activity and deliver endogenous molecules at the same site for the most efficient feedback regulation. Here, we address this challenge with an organic electronic multifunctional device that is capable of chemical stimulation and electrical sensing at the same site, at the single-cell scale. Conducting polymer electrodes recorded epileptiform discharges induced in mouse hippocampal preparation. The inhibitory neurotransmitter, γ-aminobutyric acid (GABA), was then actively delivered through the recording electrodes via organic electronic ion pump technology. GABA delivery stopped epileptiform activity, recorded simultaneously and colocally. This multifunctional “neural pixel” creates a range of opportunities, including implantable therapeutic devices with automated feedback, where locally recorded signals regulate local release of specific therapeutic agents. PMID:27506784

Information Management: The Challenges of Managing Electronic Records. Testimony Before the Subcommittee on Information Policy, Census and National Archives, Committee on Oversight and Government Reform, House of Representatives. GAO-10-838T

ERIC Educational Resources Information Center

Melvin, Valerie C.

2010-01-01

Federal agencies are increasingly using electronic means to create, exchange, and store information, and in doing so, they frequently create federal records: that is, information, in whatever form, that documents government functions, activities, decisions, and other important transactions. As the volume of electronic information grows, so does…

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

Code of Federal Regulations, 2011 CFR

2011-07-01

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS... to document program policies, procedures, functions, activities, and transactions; (b) The office... administrator responsible for ensuring authenticity, protection, and ready retrieval of electronic records; (c...

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

Code of Federal Regulations, 2012 CFR

2012-07-01

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS... to document program policies, procedures, functions, activities, and transactions; (b) The office... administrator responsible for ensuring authenticity, protection, and ready retrieval of electronic records; (c...

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

Code of Federal Regulations, 2014 CFR

2014-07-01

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF FEDERAL RECORDS... to document program policies, procedures, functions, activities, and transactions; (b) The office... administrator responsible for ensuring authenticity, protection, and ready retrieval of electronic records; (c...

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.

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

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...

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.

78 FR 48913 - Agency Information Collection Activities: Submission to OMB for Reinstatement, Without Change, of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-12

... electronic funds transfer information to maintain its vendor (credit union) records to make electronic... maintain current electronic funds transfer data for its vendor (credit union) electronic routing and... the information on the respondents such as through the use of automated collection techniques or other...

Mapping brain activity with flexible graphene micro-transistors

NASA Astrophysics Data System (ADS)

Blaschke, Benno M.; Tort-Colet, Núria; Guimerà-Brunet, Anton; Weinert, Julia; Rousseau, Lionel; Heimann, Axel; Drieschner, Simon; Kempski, Oliver; Villa, Rosa; Sanchez-Vives, Maria V.; Garrido, Jose A.

2017-06-01

Establishing a reliable communication interface between the brain and electronic devices is of paramount importance for exploiting the full potential of neural prostheses. Current microelectrode technologies for recording electrical activity, however, evidence important shortcomings, e.g. challenging high density integration. Solution-gated field-effect transistors (SGFETs), on the other hand, could overcome these shortcomings if a suitable transistor material were available. Graphene is particularly attractive due to its biocompatibility, chemical stability, flexibility, low intrinsic electronic noise and high charge carrier mobilities. Here, we report on the use of an array of flexible graphene SGFETs for recording spontaneous slow waves, as well as visually evoked and also pre-epileptic activity in vivo in rats. The flexible array of graphene SGFETs allows mapping brain electrical activity with excellent signal-to-noise ratio (SNR), suggesting that this technology could lay the foundation for a future generation of in vivo recording implants.

The Electronically Activated Recorder (EAR): A Method for the Naturalistic Observation of Daily Social Behavior

PubMed Central

Mehl, Matthias R.

2016-01-01

This article reviews the Electronically Activated Recorder or EAR as an ambulatory ecological momentary assessment tool for the real-world observation of daily behavior. Technically, the EAR is an audio recorder that intermittently records snippets of ambient sounds while participants go about their lives. Conceptually, it is a naturalistic observation method that yields an acoustic log of a person’s day as it unfolds. The power of the EAR lies in unobtrusively collecting authentic real-life observational data. In preserving a high degree of naturalism at the level of the raw recordings, it resembles ethnographic methods; through its sampling and coding, it enables larger empirical studies. The article provides an overview of the EAR method, reviews its validity, utility, and limitations, and discusses it in the context of current developments in ambulatory assessment, specifically the emerging field of mobile sensing. PMID:28529411

The Electronically Activated Recorder (EAR): A Method for the Naturalistic Observation of Daily Social Behavior.

PubMed

Mehl, Matthias R

2017-04-01

This article reviews the Electronically Activated Recorder or EAR as an ambulatory ecological momentary assessment tool for the real-world observation of daily behavior. Technically, the EAR is an audio recorder that intermittently records snippets of ambient sounds while participants go about their lives. Conceptually, it is a naturalistic observation method that yields an acoustic log of a person's day as it unfolds. The power of the EAR lies in unobtrusively collecting authentic real-life observational data. In preserving a high degree of naturalism at the level of the raw recordings, it resembles ethnographic methods; through its sampling and coding, it enables larger empirical studies. The article provides an overview of the EAR method, reviews its validity, utility, and limitations, and discusses it in the context of current developments in ambulatory assessment, specifically the emerging field of mobile sensing.

Programmable hyperspectral image mapper with on-array processing

NASA Technical Reports Server (NTRS)

Cutts, James A. (Inventor)

1995-01-01

A hyperspectral imager includes a focal plane having an array of spaced image recording pixels receiving light from a scene moving relative to the focal plane in a longitudinal direction, the recording pixels being transportable at a controllable rate in the focal plane in the longitudinal direction, an electronic shutter for adjusting an exposure time of the focal plane, whereby recording pixels in an active area of the focal plane are removed therefrom and stored upon expiration of the exposure time, an electronic spectral filter for selecting a spectral band of light received by the focal plane from the scene during each exposure time and an electronic controller connected to the focal plane, to the electronic shutter and to the electronic spectral filter for controlling (1) the controllable rate at which the recording is transported in the longitudinal direction, (2) the exposure time, and (3) the spectral band so as to record a selected portion of the scene through M spectral bands with a respective exposure time t(sub q) for each respective spectral band q.

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...

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.

78 FR 17221 - Agency Information Collection Activities: Interagency Record of Request A, G, or NATO Dependent...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-20

...-0027] Agency Information Collection Activities: Interagency Record of Request A, G, or NATO Dependent Employment Authorization or Change/ Adjustment To/From A, G, or NATO Status, Form I-566; Revision of a... techniques or other forms of information technology, e.g., permitting electronic submission of responses...

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.

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

78 FR 17646 - Agency Information Collection Activities; eZ-Audit: Electronic Submission of Financial Statements...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

...Z-Audit: Electronic Submission of Financial Statements and Compliance Audits AGENCY: Federal Student... in response to this notice will be considered public records. Title of Collection: eZ-Audit: Electronic Submission of Financial Statements and Compliance Audits. OMB Control Number: 1845-0072. Type of...

Bioresorbable silicon electronics for transient spatiotemporal mapping of electrical activity from the cerebral cortex.

PubMed

Yu, Ki Jun; Kuzum, Duygu; Hwang, Suk-Won; Kim, Bong Hoon; Juul, Halvor; Kim, Nam Heon; Won, Sang Min; Chiang, Ken; Trumpis, Michael; Richardson, Andrew G; Cheng, Huanyu; Fang, Hui; Thomson, Marissa; Bink, Hank; Talos, Delia; Seo, Kyung Jin; Lee, Hee Nam; Kang, Seung-Kyun; Kim, Jae-Hwan; Lee, Jung Yup; Huang, Younggang; Jensen, Frances E; Dichter, Marc A; Lucas, Timothy H; Viventi, Jonathan; Litt, Brian; Rogers, John A

2016-07-01

Bioresorbable silicon electronics technology offers unprecedented opportunities to deploy advanced implantable monitoring systems that eliminate risks, cost and discomfort associated with surgical extraction. Applications include postoperative monitoring and transient physiologic recording after percutaneous or minimally invasive placement of vascular, cardiac, orthopaedic, neural or other devices. We present an embodiment of these materials in both passive and actively addressed arrays of bioresorbable silicon electrodes with multiplexing capabilities, which record in vivo electrophysiological signals from the cortical surface and the subgaleal space. The devices detect normal physiologic and epileptiform activity, both in acute and chronic recordings. Comparative studies show sensor performance comparable to standard clinical systems and reduced tissue reactivity relative to conventional clinical electrocorticography (ECoG) electrodes. This technology offers general applicability in neural interfaces, with additional potential utility in treatment of disorders where transient monitoring and modulation of physiologic function, implant integrity and tissue recovery or regeneration are required.

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

PubMed Central

Rinkus, Susan M.; Chitwood, Ainsley

2002-01-01

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

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

PubMed Central

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

2010-01-01

Background: Electronic medical records (EMRs) provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS) involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution's initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting) strategy within the EMR. Methods: A focus group of our hospital's transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium) for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater realered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encount by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also enhance data mining, quality improvement, and biovigilance monitoring activities. PMID:20805955

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

78 FR 59375 - Agency Information Collection Activities: Submission to OMB for Reinstatement, Without Change, of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-26

... transfer information to maintain its vendor (credit union) records to make electronic payments to credit... current electronic funds transfer data for its vendor (credit union) electronic routing and transit data... such as through the use of automated collection techniques or other forms of information technology. It...

Interfacing with the brain using organic electronics (Presentation Recording)

NASA Astrophysics Data System (ADS)

Malliaras, George G.

2015-10-01

Implantable electrodes are being used for diagnostic purposes, for brain-machine interfaces, and for delivering electrical stimulation to alleviate the symptoms of diseases such as Parkinson's. The field of organic electronics made available devices with a unique combination of attractive properties, including mixed ionic/electronic conduction, mechanical flexibility, enhanced biocompatibility, and capability for drug delivery. I will present examples of organic electrodes, transistors and other devices for recording and stimulation of brain activity and discuss how they can improve our understanding of brain physiology and pathology, and how they can be used to deliver new therapies.

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

Use of a Nationwide Personally Controlled Electronic Health Record by Healthcare Professionals and Patients: A Case Study with the French DMP.

PubMed

Seroussi, Brigitte; Bouaud, Jacques

2017-01-01

If the wide adoption of electronic health records (EHRs) is necessary to address health information sharing and care coordination issues, it is not sufficient. In order to address health information sharing, some countries, among which, France, have implemented a centralized framework with "new" nationwide care records. The French DMP is a centralized, nationally shared, electronic medical record, created according to the opt-in model. More than five years after the launching of the DMP project, DMPs have been created for 1.5% of the target population, which demonstrates the poor adoption of the tool by healthcare professionals. Among the 583,997 existing DMPs in June 2016, 41% were empty, and 24% of non-empty DMPs were actually accessed. If these "active" DMPs were equally accessed by both healthcare professionals and patients, patients accessed DMP documents four times more than healthcare professionals.

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.

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

41 CFR 60-300.81 - Access to records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... REGARDING DISABLED VETERANS, RECENTLY SEPARATED VETERANS, ACTIVE DUTY WARTIME OR CAMPAIGN BADGE VETERANS... conducting on-site compliance evaluations and complaint investigations and inspecting and copying such books... provide OFCCP access to these materials, including electronic records, off-site for purposes of conducting...

75 FR 58395 - Agency Information Collection Activities: Proposed Collection: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-24

... Technology Planning Grants, Electronic Health Record Implementation Health Center Controlled Networks, Health... Records Implementation for Health Center Controlled Networks and Large Multi Site Health Centers. In order... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency...

Equivalent Circuit of the Neuro-Electronic Junction for Signal Recordings From Planar and Engulfed Micro-Nano-Electrodes.

PubMed

Massobrio, Giuseppe; Martinoia, Sergio; Massobrio, Paolo

2018-02-01

In the latest years, several attempts to develop extracellular microtransducers to record electrophysiological activity of excitable cells have been done. In particular, many efforts have been oriented to increase the coupling conditions, and, thus, improving the quality of the recorded signal. Gold mushroom-shaped microelectrodes (GMμE) are an example of nano-devices to achieve those requirements. In this study, we developed an equivalent electrical circuit of the neuron-microelectrode system interface to simulate signal recordings from both planar and engulfed micro-nano-electrodes. To this purpose, models of the neuron, planar, gold planar microelectrode, and GMμE, neuro-electronic junction (microelectrode-electrolyte interface, cleft effect, and protein-glycocalyx electric double layer) are presented. Then, neuronal electrical activity is simulated by Hspice software, and analyzed as a function of the most sensitive biophysical models parameters, such as the neuron-microelectrode cleft width, spreading and seal resistances, ion-channel densities, double-layer properties, and microelectrode geometries. Results are referenced to the experimentally recorded electrophysiological neuronal signals reported in the literature.

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

The Electronic Supervisor: New Technology, New Tensions.

ERIC Educational Resources Information Center

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

Computer technology has made it possible for employers to collect and analyze management information about employees' work performance and equipment use. There are three main tools for supervising office activities. Computer-based (electronic) monitoring systems automatically record statistics about the work of employees using computer or…

In vivo recordings of brain activity using organic transistors

PubMed Central

Khodagholy, Dion; Doublet, Thomas; Quilichini, Pascale; Gurfinkel, Moshe; Leleux, Pierre; Ghestem, Antoine; Ismailova, Esma; Hervé, Thierry; Sanaur, Sébastien; Bernard, Christophe; Malliaras, George G.

2013-01-01

In vivo electrophysiological recordings of neuronal circuits are necessary for diagnostic purposes and for brain-machine interfaces. Organic electronic devices constitute a promising candidate because of their mechanical flexibility and biocompatibility. Here we demonstrate the engineering of an organic electrochemical transistor embedded in an ultrathin organic film designed to record electrophysiological signals on the surface of the brain. The device, tested in vivo on epileptiform discharges, displayed superior signal-to-noise ratio due to local amplification compared with surface electrodes. The organic transistor was able to record on the surface low-amplitude brain activities, which were poorly resolved with surface electrodes. This study introduces a new class of biocompatible, highly flexible devices for recording brain activity with superior signal-to-noise ratio that hold great promise for medical applications. PMID:23481383

In vivo recordings of brain activity using organic transistors.

PubMed

Khodagholy, Dion; Doublet, Thomas; Quilichini, Pascale; Gurfinkel, Moshe; Leleux, Pierre; Ghestem, Antoine; Ismailova, Esma; Hervé, Thierry; Sanaur, Sébastien; Bernard, Christophe; Malliaras, George G

2013-01-01

In vivo electrophysiological recordings of neuronal circuits are necessary for diagnostic purposes and for brain-machine interfaces. Organic electronic devices constitute a promising candidate because of their mechanical flexibility and biocompatibility. Here we demonstrate the engineering of an organic electrochemical transistor embedded in an ultrathin organic film designed to record electrophysiological signals on the surface of the brain. The device, tested in vivo on epileptiform discharges, displayed superior signal-to-noise ratio due to local amplification compared with surface electrodes. The organic transistor was able to record on the surface low-amplitude brain activities, which were poorly resolved with surface electrodes. This study introduces a new class of biocompatible, highly flexible devices for recording brain activity with superior signal-to-noise ratio that hold great promise for medical applications.

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

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.

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.

76 FR 9024 - Agency Information Collection Activities; Proposed Collection; Comment Request; Electronic...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-16

....300) require the following standard operating procedures to assure appropriate use of, and precautions for, systems using electronic records and signatures: (1) Sec. 11.10 specifies procedures and controls... burden associated with the creation of standard operating procedures, validation, and certification. The...

Electron impact action spectroscopy of mass/charge selected macromolecular ions: Inner-shell excitation of ubiquitin protein

NASA Astrophysics Data System (ADS)

Ranković, Miloš Lj.; Giuliani, Alexandre; Milosavljević, Aleksandar R.

2016-02-01

We have performed inner-shell electron impact action spectroscopy of mass and charge selected macromolecular ions. For this purpose, we have coupled a focusing electron gun with a linear quadrupole ion trap mass spectrometer. This experiment represents a proof of principle that an energy-tunable electron beam can be used in combination with radio frequency traps as an activation method in tandem mass spectrometry (MS2) and allows performing action spectroscopy. Electron impact MS2 spectra of multiply protonated ubiquitin protein ion have been recorded at incident electron energies around the carbon 1 s excitation. Both MS2 and single ionization energy dependence spectra are compared with literature data obtained using the soft X-ray activation conditions.

Altitude distribution of electron concentration in ionospheric D-region in presence of time-varying solar radiation flux

NASA Astrophysics Data System (ADS)

Nina, A.; Čadež, V.; Srećković, V.; Šulić, D.

2012-05-01

In this paper, we study the influence of solar flares on electron concentration in the terrestrial ionospheric D-region by analyzing the amplitude and phase time variations of very low frequency (VLF) radio waves emitted by DHO transmitter (Germany) and recorded by the AWESOME receiver in Belgrade (Serbia) in real time. The rise of photo-ionization rate in the ionospheric D-region is a typical consequence of solar flare activity as recorded by GOES-15 satellite for the event on March 24, 2011 between 12:01 UT and 12:11 UT. At altitudes around 70 km, the photo-ionization and recombination are the dominant electron gain and electron loss processes, respectively. We analyze the relative contribution of each of these two processes in the resulting electron concentration variation in perturbed ionosphere.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-19

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

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...

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...

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.

Understanding the nature of information seeking behavior in critical care: implications for the design of health information technology.

PubMed

Kannampallil, Thomas G; Franklin, Amy; Mishra, Rashmi; Almoosa, Khalid F; Cohen, Trevor; Patel, Vimla L

2013-01-01

Information in critical care environments is distributed across multiple sources, such as paper charts, electronic records, and support personnel. For decision-making tasks, physicians have to seek, gather, filter and organize information from various sources in a timely manner. The objective of this research is to characterize the nature of physicians' information seeking process, and the content and structure of clinical information retrieved during this process. Eight medical intensive care unit physicians provided a verbal think-aloud as they performed a clinical diagnosis task. Verbal descriptions of physicians' activities, sources of information they used, time spent on each information source, and interactions with other clinicians were captured for analysis. The data were analyzed using qualitative and quantitative approaches. We found that the information seeking process was exploratory and iterative and driven by the contextual organization of information. While there was no significant differences between the overall time spent paper or electronic records, there was marginally greater relative information gain (i.e., more unique information retrieved per unit time) from electronic records (t(6)=1.89, p=0.1). Additionally, information retrieved from electronic records was at a higher level (i.e., observations and findings) in the knowledge structure than paper records, reflecting differences in the nature of knowledge utilization across resources. A process of local optimization drove the information seeking process: physicians utilized information that maximized their information gain even though it required significantly more cognitive effort. Implications for the design of health information technology solutions that seamlessly integrate information seeking activities within the workflow, such as enriching the clinical information space and supporting efficient clinical reasoning and decision-making, are discussed. Copyright © 2012 Elsevier B.V. All rights reserved.

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.

42 CFR 495.352 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... activities performed during the quarter, including progress in implementing the State's approved Medicaid HIT...

Framework and prototype for a secure XML-based electronic health records system.

PubMed

Steele, Robert; Gardner, William; Chandra, Darius; Dillon, Tharam S

2007-01-01

Security of personal medical information has always been a challenge for the advancement of Electronic Health Records (EHRs) initiatives. eXtensible Markup Language (XML), is rapidly becoming the key standard for data representation and transportation. The widespread use of XML and the prospect of its use in the Electronic Health (e-health) domain highlights the need for flexible access control models for XML data and documents. This paper presents a declarative access control model for XML data repositories that utilises an expressive XML role control model. The operational semantics of this model are illustrated by Xplorer, a user interface generation engine which supports search-browse-navigate activities on XML repositories.

Neurotrophic Electrode: Method of assembly and implantation into human motor speech cortex

PubMed Central

Bartels, Jess; Andreasen, Dinal; Ehirim, Princewill; Mao, Hui; Seibert, Steven; Wright, E Joe; Kennedy, Philip

2008-01-01

The Neurotrophic Electrode (NE) is designed for longevity and stability of recorded signals. To achieve this aim it induces neurites to grow through its glass tip, thus anchoring it in neuropil. The glass tip contains insulated gold wires for recording the activity of the myelinated neurites that grow into the tip. Neural signals inside the tip are electrically insulated from surrounding neural activity by the glass. The most recent version of the electrode has four wires inside its tip to maximize the number of discriminable signals recorded from ingrown neurites, and has a miniature connector. Flexible coiled, insulated gold wires connect to electronics on the skull that remain subcutaneous. The implanted electronics consist of differential amplifiers, FM transmitters, and a sine wave at power up for tuning and calibration. Inclusion criteria for selecting locked-in subjects include medical stability, normal cognition, and strong caregiver support. The implant target is localized via an fMRI-naming task. Final localization at surgery is achieved by 3D stereotaxic localization. During recording, implanted electronics are powered by magnetic induction across an air gap. Coiled antennas placed on the scalp over the implanted transmitters receive the amplified FM transmitter outputs. Data is processed as described elsewhere where stability and longevity issues are addressed. Five subjects have been successfully implanted with the NE. Recorded signals persisted for over four years in two subjects who died from underlying illnesses, and continue for over three years in our present subject. PMID:18672003

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.

Electron impact action spectroscopy of mass/charge selected macromolecular ions: Inner-shell excitation of ubiquitin protein

DOE PAGES

Rankovic, Milos Lj.; Giuliani, Alexandre; Milosavljevic, Aleksandar R.

2016-02-11

In this study, we have performed inner-shell electron impact action spectroscopy of mass and charge selected macromolecular ions. For this purpose, we have coupled a focusing electron gun with a linear quadrupole ion trap mass spectrometer. This experiment represents a proof of principle that an energy-tunable electron beam can be used in combination with radio frequency traps as an activation method in tandem mass spectrometry (MS 2) and allows performing action spectroscopy. Electron impact MS 2 spectra of multiply protonated ubiquitin protein ion have been recorded at incident electron energies around the carbon 1s excitation. Both MS 2 and singlemore » ionization energy dependence spectra are compared with literature data obtained using the soft X-ray activation conditions.« less

Electron impact action spectroscopy of mass/charge selected macromolecular ions: Inner-shell excitation of ubiquitin protein

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

Rankovic, Milos Lj.; Giuliani, Alexandre; Milosavljevic, Aleksandar R.

In this study, we have performed inner-shell electron impact action spectroscopy of mass and charge selected macromolecular ions. For this purpose, we have coupled a focusing electron gun with a linear quadrupole ion trap mass spectrometer. This experiment represents a proof of principle that an energy-tunable electron beam can be used in combination with radio frequency traps as an activation method in tandem mass spectrometry (MS 2) and allows performing action spectroscopy. Electron impact MS 2 spectra of multiply protonated ubiquitin protein ion have been recorded at incident electron energies around the carbon 1s excitation. Both MS 2 and singlemore » ionization energy dependence spectra are compared with literature data obtained using the soft X-ray activation conditions.« less

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

PubMed Central

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

2013-01-01

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

Connecting Professional Practice and Technology at the Bedside

PubMed Central

Gomes, Melissa; Hash, Pamela; Orsolini, Liana; Watkins, Aimee; Mazzoccoli, Andrea

2016-01-01

The purpose of this research is to determine the effects of implementing an electronic health record on medical-surgical registered nurses' time spent in direct professional patient-centered nursing activities, attitudes and beliefs related to implementation, and changes in level of nursing engagement after deployment of the electronic health record. Patient-centered activities were categorized using Watson's Caritas Processes and the Relationship-Based Care Delivery System. Methods included use of an Attitudes and Beliefs Assessment Questionnaire, Nursing Engagement Questionnaire, and Rapid Modeling Corporation's personal digital assistants for time and motion data collection. There was a significant difference in normative belief between nurses with less than 15 years' experience and nurses with more than 15 years' experience (t21 = 2.7, P = .01). While nurses spent less time at the nurses' station, less time charting, significantly more time in patients' rooms and in purposeful interactions, time spent in relationship-based caring behavior categories actually decreased in most categories. Nurses' engagement scores did not significantly increase. These results serve to inform healthcare organizations about potential factors related to electronic health record deployment which create shifts in nursing time spent across care categories and can be used to explore further patient centered care practices. PMID:27496045

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

Foundation for Integrating Employee Health Activities for Active Duty Personnel in the Department of Defense

DTIC Science & Technology

2009-01-01

the intent of DoD’s electronic health record, AHLTA, which will eventually contain all health uti - lization information in a single record. However...service) Health monitoring Serum sample Prescription medications Immunizations Pregnancy test Health monitoring Required (varies by service) Periodic...FedEx in 2002, but it should be noted that these are unpublished. FedEx reports that the HCM program has reduced costs and uti - lization of heath-care

Miniature penetrator (MinPen) acceleration recorder development test

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

Franco, R.J.; Platzbecker, M.R.

1998-08-01

The Telemetry Technology Development Department at Sandia National Laboratories actively develops and tests acceleration recorders for penetrating weapons. This new acceleration recorder (MinPen) utilizes a microprocessor-based architecture for operational flexibility while maintaining electronics and packaging techniques developed over years of penetrator testing. MinPen has been demonstrated to function in shock environments up to 20,000 Gs. The MinPen instrumentation development has resulted in a rugged, versatile, miniature acceleration recorder and is a valuable tool for penetrator testing in a wide range of applications.

75 FR 68610 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-08

... asked about Electronic Health Record (EHR) reporting capabilities. Also, a limited number of clinical... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities: Submission for OMB Review; Comment Request Periodically, the Health...

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

PubMed Central

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

2014-01-01

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

Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.

PubMed

Baer, Heather J; Wee, Christina C; DeVito, Katerina; Orav, E John; Frolkis, Joseph P; Williams, Deborah H; Wright, Adam; Bates, David W

2015-08-01

Primary care providers often fail to identify patients who are overweight or obese or discuss weight management with them. Electronic health record-based tools may help providers with the assessment and management of overweight and obesity. We describe the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients, as well as the challenges we encountered. We developed several new features within the electronic health record used by primary care practices affiliated with Brigham and Women's Hospital in Boston, MA. These features included (1) reminders to measure height and weight, (2) an alert asking providers to add overweight or obesity to the problem list, (3) reminders with tailored management recommendations, and (4) a Weight Management screen. We then conducted a pragmatic, cluster-randomized controlled trial in 12 primary care practices. We randomized 23 clinical teams ("clinics") within the practices to the intervention group (n = 11) or the control group (n = 12). The new features were activated only for clinics in the intervention group. The intervention was implemented in two phases: the height and weight reminders went live on 15 December 2011 (Phase 1), and all of the other features went live on 11 June 2012 (Phase 2). Study enrollment went from December 2011 through December 2012, and follow-up ended in December 2013. The primary outcomes were 6-month and 12-month weight change among adult patients with body mass index ≥25 who had a visit at one of the primary care clinics during Phase 2. Secondary outcome measures included the proportion of patients with a recorded body mass index in the electronic health record, the proportion of patients with body mass index ≥25 who had a diagnosis of overweight or obesity on the electronic health record problem list, and the proportion of patients with body mass index ≥25 who had a follow-up appointment about their weight or were prescribed weight loss medication. We encountered challenges in our development of an intervention within the existing structure of an electronic health record. For example, although we decided to randomize clinics within primary care practices, this decision may have introduced contamination and led to some imbalance of patient characteristics between the intervention and control practices. Using the electronic health record as the primary data source reduced the cost of the study, but not all desired data were recorded for every participant. Despite the challenges, this study should provide valuable information about the effectiveness of electronic health record-based tools for addressing overweight and obesity in primary care. © The Author(s) 2015.

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...

The Relationship Between Magnet Designation, Electronic Health Record Adoption, and Medicare Meaningful Use Payments.

PubMed

Lippincott, Christine; Foronda, Cynthia; Zdanowicz, Martin; McCabe, Brian E; Ambrosia, Todd

2017-08-01

The objective of this study was to examine the relationship between nursing excellence and electronic health record adoption. Of 6582 US hospitals, 4939 were eligible for the Medicare Electronic Health Record Incentive Program, and 6419 were eligible for evaluation on the HIMSS Analytics Electronic Medical Record Adoption Model. Of 399 Magnet hospitals, 330 were eligible for the Medicare Electronic Health Record Incentive Program, and 393 were eligible for evaluation in the HIMSS Analytics Electronic Medical Record Adoption Model. Meaningful use attestation was defined as receipt of a Medicare Electronic Health Record Incentive Program payment. The adoption electronic health record was defined as Level 6 and/or 7 on the HIMSS Analytics Electronic Medical Record Adoption Model. Logistic regression showed that Magnet-designated hospitals were more likely attest to Meaningful Use than non-Magnet hospitals (odds ratio = 3.58, P < .001) and were more likely to adopt electronic health records than non-Magnet hospitals (Level 6 only: odds ratio = 3.68, P < .001; Level 6 or 7: odds ratio = 4.02, P < .001). This study suggested a positive relationship between Magnet status and electronic health record use, which involves earning financial incentives for successful adoption. Continued investigation is needed to examine the relationships between the quality of nursing care, electronic health record usage, financial implications, and patient outcomes.

Relation between precipitation of energetic electrons, field-aligned currents, and the westward electrojet

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

Dronov, A.V.; Tsirs, V.E.

1988-11-01

We have investigated the relation between the precipitation of energetic electrons and protons (>30 keV), field aligned currents, and the position of the westward electrojet during the active phase of substorms. Our work is based on measurements by Kosmos-426 in November 11-12 and 22-25, 1971, and by Kosmos-900 and Interkosmos-17 in December 1-2, 1977. Maximum fluxes of precipitating energetic electrons arrive in the region of outflowing current. Maximum fluxes of protons are precipitated preferentially in regions of inflowing current. During the active phase of substorms, the maximum fluxes of energetic electrons are recorded at the leading edge of the westwardmore » electrojet.« less

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.

Opportunities and challenges in integrating electronic health records into undergraduate medical education: a national survey of clerkship directors.

PubMed

Hammoud, Maya M; Margo, Katherine; Christner, Jennifer G; Fisher, Jonathan; Fischer, Shira H; Pangaro, Louis N

2012-01-01

Few studies have reported on the utilization and the effect of electronic health records on the education of medical students. The purpose of this study was to describe the current use of electronic health records by medical students in the United States and explore the opportunities and challenges of integrating electronic health records into daily teaching of medical students. A survey with 24 questions regarding the use of electronic health records by medical students was developed by the Alliance for Clinical Educators and sent to clerkship directors across the United States. Both quantitative and qualitative responses were collected and analyzed to determine current access to and use of electronic health records by medical students. This study found that an estimated 64% of programs currently allow student use of electronic health records, of which only two thirds allowed students to write notes within the electronic record. Overall, clerkship directors' opinions on the effects of electronic health records on medical student education were neutral, and despite acknowledging many advantages to electronic health records, there were many concerns raised regarding their use in education. Medical students are using electronic health records at higher rates than physicians in practice. Although this is overall reassuring, educators have to be cautious about the limitations being placed on student's documentation in electronic health records as this can potentially have consequences on their training, and they need to explore ways to maximize the benefits of electronic health records in medical education.

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE REGULATIONS (CONTINUED) ELECTRONIC RETIREMENT PROCESSING Records § 850.301 Electronic records; other acceptable records. (a) Acceptable electronic records for retirement and insurance processing by... (SF 2806 or SF 3100), or data or images obtained from such documents, including images stored in EDMS...

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

Code of Federal Regulations, 2013 CFR

2013-07-01

... requirements apply to electronic records? § 1235.44 Section § 1235.44 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF RECORDS TO THE NATIONAL... requirements apply to electronic records? (a) Each agency must retain a copy of permanent electronic records...

21 CFR 11.70 - Signature/record linking.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Signature/record linking. 11.70 Section 11.70 Food... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.70 Signature/record linking. Electronic signatures and handwritten signatures executed to electronic records shall be linked to their respective...

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

Magnetocardiography with sensors based on giant magnetoresistance

NASA Astrophysics Data System (ADS)

Pannetier-Lecoeur, M.; Parkkonen, L.; Sergeeva-Chollet, N.; Polovy, H.; Fermon, C.; Fowley, C.

2011-04-01

Biomagnetic signals, mostly due to the electrical activity in the body, are very weak and they can only be detected by the most sensitive magnetometers, such as Superconducting Quantum Interference Devices (SQUIDs). We report here biomagnetic recordings with hybrid sensors based on Giant MagnetoResistance (GMR). We recorded magnetic signatures of the electric activity of the human heart (magnetocardiography) in healthy volunteers. The P-wave and QRS complex, known from the corresponding electric recordings, are clearly visible in the recordings after an averaging time of about 1 min. Multiple recordings at different locations over the chest yielded a dipolar magnetic field map and allowed localizing the underlying current sources. The sensitivity of the GMR-based sensors is now approaching that of SQUIDs and paves way for spin electronics devices for functional imaging of the body.

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.

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

The Effect of Age and Task Difficulty

ERIC Educational Resources Information Center

Mallo, Jason; Nordstrom, Cynthia R.; Bartels, Lynn K.; Traxler, Anthony

2007-01-01

Electronic Performance Monitoring (EPM) is a common technique used to record employee performance. EPM may include counting computer keystrokes, monitoring employees' phone calls or internet activity, or documenting time spent on work activities. Despite EPM's prevalence, no studies have examined how this management tool affects older workers--a…

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

Code of Federal Regulations, 2013 CFR

2013-07-01

... requirements for managing electronic mail records? § 1236.22 Section § 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT... management requirements for electronic mail records: (1) The names of sender and all addressee(s) and date...

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

36 CFR 1236.28 - What additional requirements apply to the selection and maintenance of electronic records storage...

Code of Federal Regulations, 2012 CFR

2012-07-01

... apply to the selection and maintenance of electronic records storage media for permanent records? 1236... What additional requirements apply to the selection and maintenance of electronic records storage media for permanent records? (a) Agencies must maintain the storage and test areas for electronic records...

36 CFR 1236.28 - What additional requirements apply to the selection and maintenance of electronic records storage...

Code of Federal Regulations, 2014 CFR

2014-07-01

... apply to the selection and maintenance of electronic records storage media for permanent records? 1236... What additional requirements apply to the selection and maintenance of electronic records storage media for permanent records? (a) Agencies must maintain the storage and test areas for electronic records...

36 CFR § 1235.50 - What specifications and standards for transfer apply to electronic records?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF RECORDS TO THE... Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi Road... and Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi...

78 FR 22345 - Advisory Committee on the Electronic Records Archives (ACERA)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic... United States, on technical, mission, and service issues related to the Electronic Records Archives (ERA...

77 FR 21812 - Advisory Committee on the Electronic Records Archives (ACERA).

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic... United States, on technical, mission, and service issues related to the Electronic Records Archives (ERA...

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2012 CFR

2012-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2013 CFR

2013-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2011 CFR

2011-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

5 CFR 850.301 - Electronic records; other acceptable records.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

Integration of clinical research documentation in electronic health records.

PubMed

Broach, Debra

2015-04-01

Clinical trials of investigational drugs and devices are often conducted within healthcare facilities concurrently with clinical care. With implementation of electronic health records, new communication methods are required to notify nonresearch clinicians of research participation. This article reviews clinical research source documentation, the electronic health record and the medical record, areas in which the research record and electronic health record overlap, and implications for the research nurse coordinator in documentation of the care of the patient/subject. Incorporation of clinical research documentation in the electronic health record will lead to a more complete patient/subject medical record in compliance with both research and medical records regulations. A literature search provided little information about the inclusion of clinical research documentation within the electronic health record. Although regulations and guidelines define both source documentation and the medical record, integration of research documentation in the electronic health record is not clearly defined. At minimum, the signed informed consent(s), investigational drug or device usage, and research team contact information should be documented within the electronic health record. Institutional policies should define a standardized process for this integration in the absence federal guidance. Nurses coordinating clinical trials are in an ideal position to define this integration.

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.

76 FR 19147 - Advisory Committee on the Electronic Records Archives (ACERA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-06

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives... Electronic Records Archives (ACERA). The meeting has been consolidated into one day. This meeting will be... number of individuals planning to attend must be submitted to the Electronic Records Archives Program at...

Studies of electromagnetic ion cyclotron waves using AMPTE/CCE and Dynamics Explorer

NASA Technical Reports Server (NTRS)

Erlandson, Robert E.

1993-01-01

The principal activity during the past six months has involved the analysis of ion cyclotron waves recorded from DE-2 using the magnetic field experiment and electric field experiment. The results of this study have been published in the Geophysical Research Letters (GRL). The primary finding of this paper is that ion cyclotron waves were found to heat electrons, as observed in the DE-2 Langmuir probe data, through a Landau damping process. A second activity, which was started during the last six months, involves the study of large amplitude approximately one Hz electric and magnetic field oscillations recorded in the nightside auroral zone at substorm onset. Work is under way to determine the properties of these waves and investigate any association these waves may have with the substorm initiation process. A third activity under way involves a comprehensive study of ion cyclotron waves recorded at ionospheric altitudes by DE-2. This study will be an extension of the work reported in the GRL paper and will involve a larger sampling of wave events. This paper will focus on wave properties at ionospheric altitudes. A fourth activity involves a more in-depth analysis of the acceleration mechanisms and the resulting electron distributions based on the observations presented in the GRL paper.

Observation of Relativistic Electron Microbursts in Conjunction with Intense Radiation Belt Whistler-Mode Waves

NASA Technical Reports Server (NTRS)

Kersten, K.; Cattell, C. A.; Breneman, A.; Goetz, K.; Kellogg, P. J.; Wygant, J. R.; Wilson, L. B., III; Blake, J. B.; Looper, M. D.; Roth, I.

2011-01-01

We present multi-satellite observations of large amplitude radiation belt whistler-mode waves and relativistic electron precipitation. On separate occasions during the Wind petal orbits and STEREO phasing orbits, Wind and STEREO recorded intense whistler-mode waves in the outer nightside equatorial radiation belt with peak-to-peak amplitudes exceeding 300 mV/m. During these intervals of intense wave activity, SAMPEX recorded relativistic electron microbursts in near magnetic conjunction with Wind and STEREO. This evidence of microburst precipitation occurring at the same time and at nearly the same magnetic local time and L-shell with a bursty temporal structure similar to that of the observed large amplitude wave packets suggests a causal connection between the two phenomena. Simulation studies corroborate this idea, showing that nonlinear wave.particle interactions may result in rapid energization and scattering on timescales comparable to those of the impulsive relativistic electron precipitation.

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

Code of Federal Regulations, 2012 CFR

2012-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

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

Code of Federal Regulations, 2014 CFR

2014-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

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

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

42 CFR 495.314 - Activities required to receive an incentive payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Activities required to receive an incentive payment. 495.314 Section 495.314 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD...

Technology as friend or foe? Do electronic health records increase burnout?

PubMed

Ehrenfeld, Jesse M; Wanderer, Jonathan P

2018-06-01

To summarize recent relevant studies regarding the use of electronic health records and physician burnout. Recently acquired knowledge regarding the relationship between electronic health record use, professional satisfaction, burnout, and desire to leave clinical practice are discussed. Adoption of electronic health records has increased across the United States and worldwide. Although electronic health records have many benefits, there is growing concern about the adverse consequences of their use on physician satisfaction and burnout. Poor usability, incongruent workflows, and the addition of clerical tasks to physician documentation requirements have been previously highlighted as ongoing concerns with electronic health record adoption. In multiple recent studies, electronic health records have been shown to decrease professional satisfaction, increase burnout, and the likelihood that a physician will reduce or leave clinical practice. One interventional study demonstrated a positive effect of a dedicated electronic health record entry clerk on physicians working in an outpatient practice.

36 CFR 1235.50 - What specifications and standards for transfer apply to electronic records?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF REC- ORDS TO THE... Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi Road... and Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi...

Introduction of software tools for epidemiological surveillance in infection control in Colombia

PubMed Central

Motoa, Gabriel; Vallejo, Marta; Blanco, Víctor M; Correa, Adriana; de la Cadena, Elsa; Villegas, María Virginia

2015-01-01

Introduction: Healthcare-Associated Infections (HAI) are a challenge for patient safety in the hospitals. Infection control committees (ICC) should follow CDC definitions when monitoring HAI. The handmade method of epidemiological surveillance (ES) may affect the sensitivity and specificity of the monitoring system, while electronic surveillance can improve the performance, quality and traceability of recorded information. Objective: To assess the implementation of a strategy for electronic surveillance of HAI, Bacterial Resistance and Antimicrobial Consumption by the ICC of 23 high-complexity clinics and hospitals in Colombia, during the period 2012-2013. Methods: An observational study evaluating the introduction of electronic tools in the ICC was performed; we evaluated the structure and operation of the ICC, the degree of incorporation of the software HAI Solutions and the adherence to record the required information. Results: Thirty-eight percent of hospitals (8/23) had active surveillance strategies with standard criteria of the CDC, and 87% of institutions adhered to the module of identification of cases using the HAI Solutions software. In contrast, compliance with the diligence of the risk factors for device-associated HAIs was 33%. Conclusions: The introduction of ES could achieve greater adherence to a model of active surveillance, standardized and prospective, helping to improve the validity and quality of the recorded information. PMID:26309340

Introduction of software tools for epidemiological surveillance in infection control in Colombia.

PubMed

Hernández-Gómez, Cristhian; Motoa, Gabriel; Vallejo, Marta; Blanco, Víctor M; Correa, Adriana; de la Cadena, Elsa; Villegas, María Virginia

2015-01-01

Healthcare-Associated Infections (HAI) are a challenge for patient safety in the hospitals. Infection control committees (ICC) should follow CDC definitions when monitoring HAI. The handmade method of epidemiological surveillance (ES) may affect the sensitivity and specificity of the monitoring system, while electronic surveillance can improve the performance, quality and traceability of recorded information. To assess the implementation of a strategy for electronic surveillance of HAI, Bacterial Resistance and Antimicrobial Consumption by the ICC of 23 high-complexity clinics and hospitals in Colombia, during the period 2012-2013. An observational study evaluating the introduction of electronic tools in the ICC was performed; we evaluated the structure and operation of the ICC, the degree of incorporation of the software HAI Solutions and the adherence to record the required information. Thirty-eight percent of hospitals (8/23) had active surveillance strategies with standard criteria of the CDC, and 87% of institutions adhered to the module of identification of cases using the HAI Solutions software. In contrast, compliance with the diligence of the risk factors for device-associated HAIs was 33%. The introduction of ES could achieve greater adherence to a model of active surveillance, standardized and prospective, helping to improve the validity and quality of the recorded information.

Electronic health records to support obesity-related patient care: Results from a survey of United States physicians.

PubMed

Bronder, Kayla L; Dooyema, Carrie A; Onufrak, Stephen J; Foltz, Jennifer L

2015-08-01

Obesity-related electronic health record functions increase the rates of measuring Body Mass Index, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related electronic health record functions in clinical practice and analyzes characteristics associated with increased obesity-related electronic health record sophistication. Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their electronic health record has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related electronic health record sophistication. Of the 88% of providers with an electronic health record, 83% of electronic health records calculate Body Mass Index, 52% calculate pediatric Body Mass Index percentile, and 32% flag patients with abnormal Body Mass Index values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated electronic health record include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. Few electronic health records optimally supported physician's obesity-related clinical care. The low rates of obesity-related electronic health record functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. More work can be done to develop, implement, and promote the effective utilization of obesity-related electronic health record functions to improve obesity treatment and prevention efforts. Published by Elsevier Inc.

FastStats: A to Z

MedlinePlus

... access to statistics on topics of public health importance and is organized alphabetically. Links are provided to ... Electronic Medical Records Emergency Department Visits Emphysema Exercise/Physical Activity H Health Expenditures Health Insurance Coverage Heart Disease ...

Chromatic Modulator for High Resolution CCD or APS Devices

NASA Technical Reports Server (NTRS)

Hartley, Frank T. (Inventor); Hull, Anthony B. (Inventor)

2003-01-01

A system for providing high-resolution color separation in electronic imaging. Comb drives controllably oscillate a red-green-blue (RGB) color strip filter system (or otherwise) over an electronic imaging system such as a charge-coupled device (CCD) or active pixel sensor (APS). The color filter is modulated over the imaging array at a rate three or more times the frame rate of the imaging array. In so doing, the underlying active imaging elements are then able to detect separate color-separated images, which are then combined to provide a color-accurate frame which is then recorded as the representation of the recorded image. High pixel resolution is maintained. Registration is obtained between the color strip filter and the underlying imaging array through the use of electrostatic comb drives in conjunction with a spring suspension system.

36 CFR § 1236.28 - What additional requirements apply to the selection and maintenance of electronic records storage...

Code of Federal Regulations, 2013 CFR

2013-07-01

... unscheduled data on magnetic records storage media onto tested and verified new electronic media. ... apply to the selection and maintenance of electronic records storage media for permanent records? Â... storage media for permanent records? (a) Agencies must maintain the storage and test areas for electronic...

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

PubMed

Sade, Robert M

2010-01-01

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

Principal Challenges Facing Electronic Records Management in Federal Agencies Today.

ERIC Educational Resources Information Center

Patterson, Giovanna; Sprehe, J. Timothy

2002-01-01

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

Clinical genomics in the world of the electronic health record.

PubMed

Marsolo, Keith; Spooner, S Andrew

2013-10-01

The widespread adoption of electronic health records presents a number of benefits to the field of clinical genomics. They include the ability to return results to the practitioner, to use genetic findings in clinical decision support, and to have data collected in the electronic health record that serve as a source of phenotypic information for analysis purposes. Not all electronic health records are created equal, however. They differ in their features, capabilities, and ease of use. Therefore, to understand the potential of the electronic health record, it is first necessary to understand its capabilities and the impact that implementation strategy has on usability. Specifically, we focus on the following areas: (i) how the electronic health record is used to capture data in clinical practice settings; (ii) how the implementation and configuration of the electronic health record affect the quality and availability of data; (iii) the management of clinical genetic test results and the feasibility of electronic health record integration; and (iv) the challenges of implementing an electronic health record in a research-intensive environment. This is followed by a discussion of the minimum functional requirements that an electronic health record must meet to enable the satisfactory integration of genomic results as well as the open issues that remain.

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2010 CFR

2010-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

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

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

Integrated low noise low power interface for neural bio-potentials recording and conditioning

NASA Astrophysics Data System (ADS)

Bottino, Emanuele; Martinoia, Sergio; Valle, Maurizio

2005-06-01

The recent progress in both neurobiology and microelectronics suggests the creation of new, powerful tools to investigate the basic mechanisms of brain functionality. In particular, a lot of efforts are spent by scientific community to define new frameworks devoted to the analysis of in-vitro cultured neurons. One possible approach is recording their spiking activity to monitor the coordinated cellular behaviour and get insights about neural plasticity. Due to the nature of neurons action-potentials, when considering the design of an integrated microelectronic-based recording system, a number of problems arise. First, one would desire to have a high number of recording sites (i.e. several hundreds): this poses constraints on silicon area and power consumption. In this regard, our aim is to integrate-through on-chip post-processing techniques-hundreds of bio-compatible microsensors together with CMOS standard-process low-power (i.e. some tenths of uW per channel) conditioning electronics. Each recording channel is provided with sampling electronics to insure synchronous recording so that, for example, cross-correlation between signals coming from different sites can be performed. Extra-cellular potentials are in the range of [50-150] uV, so a comparison in terms of noise-efficiency was carried out among different architectures and very low-noise pre-amplification electronics (i.e. less than 5 uVrms) was designed. As spikes measurements are made with respect to the voltage of a reference electrode, we opted for an AC-coupled differential-input preamplifier provided with band-pass filtering capability. To achieve this, we implemented large time-constant (up to seconds) integrated components in the preamp feedback path. Thus, we got rid also of random slow-drifting DC-offsets and common mode signals. The paper will present our achievements in the design and implementation of a fully integrated bio-abio interface to record neural spiking activity. In particular, preliminary results will be reported.

Your Medical Records

MedlinePlus

... sometimes, but many health care providers now keep electronic records. You might hear medical people call these EHRs — short for electronic health records . Electronic records make it easier for ...

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.

Development of the Internet-Enabled System for Exercise Telerehabilitation and Cardiovascular Training.

PubMed

Dedov, Vadim N; Dedova, Irina V

2015-07-01

Sustained exercise training could significantly improve patient rehabilitation and management of noncommunicable diseases in the community. This study aimed to develop a universal telecare system for delivery of exercise rehabilitation and cardiovascular training services at home. An innovative bilateral leg training device was equipped with an electronic system for the ongoing measurement of training activities with the device. A single-item parameter reflecting the intensity of training was monitored using several modern telecommunication technologies. According to the application protocol, eight volunteers first tried the device for 30-60 min to determine their personal training capacity. Then, they were provided with equipment to use at home for 4 weeks. Adherence to daily training was assessed by the number of training days per week, training intensity, and duration of training sessions. The system provided reliable recording of training activities with the device using (1) long-term data logging without an ongoing connection to the computer, (2) wireless monitoring and recording of training activities on a stand-alone computer, and (3) a secure cloud-based monitoring over the Internet connection using electronic devices, including smartphones. Overall analysis of recordings and phone feedbacks to participants took only approximately 5 h for the duration of study. This study, although of a pilot nature, described the comprehensive exercise telerehabilitation system integrating mobile training equipment with personalized training protocols and remote monitoring. A single-item electronic parameter of the system usage facilitated time-effective data management. Wireless connection allowed various locations of device application and several monitoring arrangements ranging from real-time monitoring to long-term recording of exercise activities. A cloud-based software platform enabled management of multiple users at distance. Implementation of this model may facilitate both accessibility and availability of personalized exercise telerehabilitation services. Further studies would validate it in the clinical and healthcare environment.

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...

Adolescent patterns of physical activity differences by gender, day, and time of day.

PubMed

Jago, Russell; Anderson, Cheryl B; Baranowski, Tom; Watson, Kathy

2005-06-01

More information about the physical activity of adolescents is needed. This study used objective measurement to investigate differences in activity patterns related to gender, body mass index (BMI), day, and time of day. Eighth-grade adolescents (37 boys, 44 girls) wore the Manufacturing Technologies Inc. (MTI) accelerometer for 4 days and kept a previous-day physical activity recall diary in the fall of 2002. Minutes per hour in sedentary, light, and moderate/vigorous activity, as recorded by the MTI, and in nine activity categories, as recorded by the diary, were calculated for three time periods (6:00 am to 2:59 pm, 3:00 pm to 6:59 pm, 7:00 pm to midnight) on each day (Thursday through Sunday). Doubly multivariate analysis of variance revealed significant gender by day by time differences in sedentary (p =0.005) and moderate/vigorous (p <0.001) activity, but no significant BMI interactions. Except on Sunday, boys were less sedentary and more active than girls during the late afternoon period. Significant gender by category (p <0.001) and day by category (p <0.001) interactions were also found in the log data. Boys spent more time engaged in TV/electronics and sports, while girls spent more time in personal care. Three activity categories (sports, social interaction, active transportation) stayed at consistent levels across days, while others varied widely by day of the week. Except on Sunday, consistent gender differences were found in activity levels, especially for the late afternoon period. Significant increases in sitting, TV/electronic games, and chores were seen for weekend days. Results support strategies to reduce sitting and electronic recreation, which may increase physical activity.

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.

Developing an integrated electronic nursing record based on standards.

PubMed

van Grunsven, Arno; Bindels, Rianne; Coenen, Chel; de Bel, Ernst

2006-01-01

The Radboud University Nijmegen Medical Centre in the Netherlands develops a multidisciplinar (Electronic Health Record) based on the latest HL7 v3 (Health Level 7 version 3) D-MIM : Care provision. As part of this process we are trying to establish which nursing diagnoses and activities are minimally required. These NMDS (Nursing Minimal Data Set) are mapped or translated to ICF (for diagnoses) and CEN1828 Structures for (for activities). The mappings will be the foundation for the development of user interfaces for the registration of nursing activities. A homegrown custom-made web based configuration tool is used to exploit the possibilities of HL7 v3. This enables a sparkling launch of user interfaces that can contain the diversity of health care work processes. The first screens will be developed to support history taking for the nursing chart of the Neurology ward. The screens will contain both Dutch NMDS items and ward specific information. This will be configured dynamically per (group of) ward(s).

32 CFR 701.21 - Electronic record.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

32 CFR 701.21 - Electronic record.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

32 CFR 701.21 - Electronic record.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

32 CFR 701.21 - Electronic record.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

32 CFR 701.21 - Electronic record.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

Direct observation of children's preferences and activity levels during interactive and online electronic games.

PubMed

Sit, Cindy H P; Lam, Jessica W K; McKenzie, Thomas L

2010-07-01

Interactive electronic games have recently been popularized and are believed to help promote children's physical activity (PA). The purpose of the study was to examine preferences and PA levels during interactive and online electronic games among overweight and nonoverweight boys and girls. Using a modification of the SOFIT, we systematically observed 70 Hong Kong Chinese children (35 boys, 35 girls; 50 nonoverweight, 20 overweight), age 9 to 12 years, during 2 60-minute recreation sessions and recorded their game mode choices and PA levels. During Session One children could play either an interactive or an online electronic bowling game and during Session Two they could play an interactive or an online electronic running game. Children chose to play the games during 94% of session time and split this time between interactive (52%) and online (48%) versions. They engaged in significantly more moderate-to-vigorous physical activity (MVPA) during interactive games than their online electronic versions (70% vs. 2% of game time). Boys and nonoverweight children expended relatively more energy during the interactive games than girls and overweight children, respectively. New-generation interactive games can facilitate physical activity in children, and given the opportunity children may select them over sedentary versions.

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.

"Urgency tip": a portable patient-activated device for objective measurement of urinary urgency.

PubMed

Kobayashi, Hideki; Araki, Isao; Tsuchida, Takayuki; Zakoji, Hidenori; Mikami, Yuki; Takeda, Masayuki; Kiyohiro, Noriaki

2007-03-01

For clinical practice and research of overactive bladder syndrome, it is essential to evaluate urgency symptoms in daily life. We have developed a portable patient-activated device to record bladder sensations. This electronic device is pocket-size and light, with five grading buttons and another button for cancellation.

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

Code of Federal Regulations, 2014 CFR

2014-07-01

... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

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

Code of Federal Regulations, 2013 CFR

2013-07-01

... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

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

Code of Federal Regulations, 2011 CFR

2011-07-01

... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

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

Code of Federal Regulations, 2012 CFR

2012-07-01

... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

77 FR 27859 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... Veterans Affairs. ACTION: Notice of New System of Records ``Virtual Lifetime Electronic Record (VLER)-VA... ``Virtual Lifetime Electronic Record (VLER)-VA'' (168VA10P2). DATES: Comments on this new system of records... Virtual Lifetime Electronic Record (VLER) is an overarching program being developed by the Department of...

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

MedlinePlus

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

Nursing Student Experiences Regarding Safe Use of Electronic Health Records: A Pilot Study of the Safety and Assurance Factors for EHR Resilience Guides.

PubMed

Whitt, Karen J; Eden, Lacey; Merrill, Katreena Collette; Hughes, Mckenna

2017-01-01

Previous research has linked improper electronic health record configuration and use with adverse patient events. In response to this problem, the US Office of the National Coordinator for Health Information Technology developed the Safety and Assurance Factors for EHR Resilience guides to evaluate electronic health records for optimal use and safety features. During the course of their education, nursing students are exposed to a variety of clinical practice settings and electronic health records. This descriptive study evaluated 108 undergraduate and 51 graduate nursing students' ratings of electronic health record features and safe practices, as well as what they learned from utilizing the computerized provider order entry and clinician communication Safety and Assurance Factors for EHR Resilience guide checklists. More than 80% of the undergraduate and 70% of the graduate students reported that they experienced user problems with electronic health records in the past. More than 50% of the students felt that electronic health records contribute to adverse patient outcomes. Students reported that many of the features assessed were not fully implemented in their electronic health record. These findings highlight areas where electronic health records can be improved to optimize patient safety. The majority of students reported that utilizing the Safety and Assurance Factors for EHR Resilience guides increased their understanding of electronic health record features.

Associations between psychometrically assessed life history strategy and daily behavior: data from the Electronically Activated Recorder (EAR)

PubMed Central

2018-01-01

Life history theory has generated cogent, well-supported hypotheses about individual differences in human biodemographic traits (e.g., age at sexual maturity) and psychometric traits (e.g., conscientiousness), but little is known about how variation in life history strategy (LHS) is manifest in quotidian human behavior. Here I test predicted associations between the self-report Arizona Life History Battery and frequencies of 12 behaviors observed over 72 h in 91 US college students using the Electronically Activated Recorder (EAR), a method of gathering periodic brief audio recordings as participants go about their daily lives. Bayesian multi-level aggregated binomial regression analysis found no strong associations between ALHB scores and behavior frequencies. One behavior, presence at amusement venues (bars, concerts, sports events) was weakly positively associated with ALHB-assessed slow LHS, contrary to prediction. These results may represent a challenge to the ALHB’s validity. However, it remains possible that situational influences on behavior, which were not measured in the present study, moderate the relationships between psychometrically-assessed LHS and quotidian behavior. PMID:29868275

Associations between psychometrically assessed life history strategy and daily behavior: data from the Electronically Activated Recorder (EAR).

PubMed

Manson, Joseph H

2018-01-01

Life history theory has generated cogent, well-supported hypotheses about individual differences in human biodemographic traits (e.g., age at sexual maturity) and psychometric traits (e.g., conscientiousness), but little is known about how variation in life history strategy (LHS) is manifest in quotidian human behavior. Here I test predicted associations between the self-report Arizona Life History Battery and frequencies of 12 behaviors observed over 72 h in 91 US college students using the Electronically Activated Recorder (EAR), a method of gathering periodic brief audio recordings as participants go about their daily lives. Bayesian multi-level aggregated binomial regression analysis found no strong associations between ALHB scores and behavior frequencies. One behavior, presence at amusement venues (bars, concerts, sports events) was weakly positively associated with ALHB-assessed slow LHS, contrary to prediction. These results may represent a challenge to the ALHB's validity. However, it remains possible that situational influences on behavior, which were not measured in the present study, moderate the relationships between psychometrically-assessed LHS and quotidian behavior.

Perceptions of electronic health record implementation: a statewide survey of physicians in Rhode Island.

PubMed

Wylie, Matthew C; Baier, Rosa R; Gardner, Rebekah L

2014-10-01

Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience. We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice. The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction. We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

Highly Crumpled All-Carbon Transistors for Brain Activity Recording.

PubMed

Yang, Long; Zhao, Yan; Xu, Wenjing; Shi, Enzheng; Wei, Wenjing; Li, Xinming; Cao, Anyuan; Cao, Yanping; Fang, Ying

2017-01-11

Neural probes based on graphene field-effect transistors have been demonstrated. Yet, the minimum detectable signal of graphene transistor-based probes is inversely proportional to the square root of the active graphene area. This fundamentally limits the scaling of graphene transistor-based neural probes for improved spatial resolution in brain activity recording. Here, we address this challenge using highly crumpled all-carbon transistors formed by compressing down to 16% of its initial area. All-carbon transistors, chemically synthesized by seamless integration of graphene channels and hybrid graphene/carbon nanotube electrodes, maintained structural integrity and stable electronic properties under large mechanical deformation, whereas stress-induced cracking and junction failure occurred in conventional graphene/metal transistors. Flexible, highly crumpled all-carbon transistors were further verified for in vivo recording of brain activity in rats. These results highlight the importance of advanced material and device design concepts to make improvements in neuroelectronics.

75 FR 63208 - Advisory Committee on the Electronic Records Archives (ACERA)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-14

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National Archives and Records Administration. ACTION: Notice of meeting. SUMMARY: In... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic...

76 FR 65218 - Advisory Committee on the Electronic Records Archives (ACERA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-20

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National Archives and Records Administration. ACTION: Notice of meeting. SUMMARY: In... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic...

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...

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What records management...

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

Code of Federal Regulations, 2011 CFR

2011-07-01

... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false What records management...

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

Code of Federal Regulations, 2012 CFR

2012-07-01

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

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

Code of Federal Regulations, 2013 CFR

2013-07-01

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

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

Code of Federal Regulations, 2014 CFR

2014-07-01

... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false What records management...

76 FR 15349 - Advisory Committee on the Electronic Records Archives (ACERA); Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-21

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA); Meeting AGENCY: National Archives and Records Administration. ACTION: Notice of Meeting. SUMMARY... Archives and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic...

Electronic health records approaches and challenges: a comparison between Malaysia and four East Asian countries.

PubMed

Abd Ghani, Mohd Khanapi; Bali, Rajeev K; Naguib, Raouf N G; Marshall, Ian M

2008-01-01

An integrated Lifetime Health Record (LHR) is fundamental for achieving seamless and continuous access to patient medical information and for the continuum of care. However, the aim has not yet been fully realised. The efforts are actively progressing around the globe. Every stage of the development of the LHR initiatives had presented peculiar challenges. The best lessons in life are those of someone else's experiences. This paper presents an overview of the development approaches undertaken by four East Asian countries in implementing a national Electronic Health Record (EHR) in the public health system. The major challenges elicited from the review including integration efforts, process reengineering, funding, people, and law and regulation will be presented, compared, discussed and used as lessons learned for the further development of the Malaysian integrated LHR.

Usability inspection to improve an electronic provincial medication repository.

PubMed

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

2013-01-01

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

Electronic health record use among cancer patients: Insights from the Health Information National Trends Survey.

PubMed

Strekalova, Yulia A

2017-04-01

Over 90% of US hospitals provide patients with access to e-copy of their health records, but the utilization of electronic health records by the US consumers remains low. Guided by the comprehensive information-seeking model, this study used data from the National Cancer Institute's Health Information National Trends Survey 4 (Cycle 4) and examined the factors that explain the level of electronic health record use by cancer patients. Consistent with the model, individual information-seeking factors and perceptions of security and utility were associated with the frequency of electronic health record access. Specifically, higher income, prior online information seeking, interest in accessing health information online, and normative beliefs were predictive of electronic health record access. Conversely, poorer general health status and lack of health care provider encouragement to use electronic health records were associated with lower utilization rates. The current findings provide theory-based evidence that contributes to the understanding of the explanatory factors of electronic health record use and suggest future directions for research and practice.

Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest.

PubMed

Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla C; Petersson, Göran I; Bath, Peter A

2016-03-01

Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. © The Author(s) 2014.

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.

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.

Implications for registry-based vaccine effectiveness studies from an evaluation of an immunization registry: a cross-sectional study.

PubMed

Mahon, Barbara E; Shea, Kimberly M; Dougherty, Nancy N; Loughlin, Anita M

2008-05-14

Population-based electronic immunization registries create the possibility of using registry data to conduct vaccine effectiveness studies which could have methodological advantages over traditional observational studies. For study validity, the base population would have to be clearly defined and the immunization status of members of the population accurately recorded in the registry. We evaluated a city-wide immunization registry, focusing on its potential as a tool to study pertussis vaccine effectiveness, especially in adolescents. We conducted two evaluations - one in sites that were active registry participants and one in sites that had implemented an electronic medical record with plans for future direct data transfer to the registry - of the ability to match patients' medical records to registry records and the accuracy of immunization records in the registry. For each site, records from current pediatric patients were chosen randomly. Data regarding pertussis-related immunizations, clinic usage, and demographic and identifying information were recorded; for 11-17-year-old subjects, information on MMR, hepatitis B, and varicella immunizations was also collected. Records were then matched, when possible, to registry records. For records with a registry match, immunization data were compared. Among 350 subjects from sites that were current registry users, 307 (87.7%) matched a registry record. Discrepancies in pertussis-related data were common for up-to-date status (22.6%), number of immunizations (34.7%), dates (10.2%), and formulation (34.4%). Among 442 subjects from sites that planned direct electronic transfer of immunization data to the registry, 393 (88.9%) would have matched a registry record; discrepancies occurred frequently in number of immunizations (11.9%), formulation (29.1%), manufacturer (94.4%), and lot number (95.1%.) Inability to match and immunization discrepancies were both more common in subjects who were older at their first visit to the provider site. For 11-17-year-old subjects, discrepancies were also common for MMR, hepatitis B, and varicella vaccination data. Provider records frequently could not be matched to registry records or had discrepancies in key immunization data. These issues were more common for older children and were present even with electronic data transfer. These results highlight general challenges that may face investigators wishing to use registry-based immunization data for vaccine effectiveness studies, especially in adolescents.

Implications for registry-based vaccine effectiveness studies from an evaluation of an immunization registry: A cross-sectional study

PubMed Central

Mahon, Barbara E; Shea, Kimberly M; Dougherty, Nancy N; Loughlin, Anita M

2008-01-01

Background Population-based electronic immunization registries create the possibility of using registry data to conduct vaccine effectiveness studies which could have methodological advantages over traditional observational studies. For study validity, the base population would have to be clearly defined and the immunization status of members of the population accurately recorded in the registry. We evaluated a city-wide immunization registry, focusing on its potential as a tool to study pertussis vaccine effectiveness, especially in adolescents. Methods We conducted two evaluations – one in sites that were active registry participants and one in sites that had implemented an electronic medical record with plans for future direct data transfer to the registry – of the ability to match patients' medical records to registry records and the accuracy of immunization records in the registry. For each site, records from current pediatric patients were chosen randomly. Data regarding pertussis-related immunizations, clinic usage, and demographic and identifying information were recorded; for 11–17-year-old subjects, information on MMR, hepatitis B, and varicella immunizations was also collected. Records were then matched, when possible, to registry records. For records with a registry match, immunization data were compared. Results Among 350 subjects from sites that were current registry users, 307 (87.7%) matched a registry record. Discrepancies in pertussis-related data were common for up-to-date status (22.6%), number of immunizations (34.7%), dates (10.2%), and formulation (34.4%). Among 442 subjects from sites that planned direct electronic transfer of immunization data to the registry, 393 (88.9%) would have matched a registry record; discrepancies occurred frequently in number of immunizations (11.9%), formulation (29.1%), manufacturer (94.4%), and lot number (95.1%.) Inability to match and immunization discrepancies were both more common in subjects who were older at their first visit to the provider site. For 11–17-year-old subjects, discrepancies were also common for MMR, hepatitis B, and varicella vaccination data. Conclusion Provider records frequently could not be matched to registry records or had discrepancies in key immunization data. These issues were more common for older children and were present even with electronic data transfer. These results highlight general challenges that may face investigators wishing to use registry-based immunization data for vaccine effectiveness studies, especially in adolescents. PMID:18479517

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

Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement.

PubMed

Cohen, Deborah J; Dorr, David A; Knierim, Kyle; DuBard, C Annette; Hemler, Jennifer R; Hall, Jennifer D; Marino, Miguel; Solberg, Leif I; McConnell, K John; Nichols, Len M; Nease, Donald E; Edwards, Samuel T; Wu, Winfred Y; Pham-Singer, Hang; Kho, Abel N; Phillips, Robert L; Rasmussen, Luke V; Duffy, F Daniel; Balasubramanian, Bijal A

2018-04-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.

Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

PubMed Central

Cohen, Deborah J.; Dorr, David A.; Knierim, Kyle; DuBard, C. Annette; Hemler, Jennifer R.; Hall, Jennifer D.; Marino, Miguel; Solberg, Leif I.; McConnell, K. John; Nichols, Len M.; Nease, Donald E.; Edwards, Samuel T.; Wu, Winfred Y.; Pham-Singer, Hang; Kho, Abel N.; Phillips, Robert L.; Rasmussen, Luke V.; Duffy, F. Daniel; Balasubramanian, Bijal A.

2018-01-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports—but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures. PMID:29608365

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.

Access control and privilege management in electronic health record: a systematic literature review.

PubMed

Jayabalan, Manoj; O'Daniel, Thomas

2016-12-01

This study presents a systematic literature review of access control for electronic health record systems to protect patient's privacy. Articles from 2006 to 2016 were extracted from the ACM Digital Library, IEEE Xplore Digital Library, Science Direct, MEDLINE, and MetaPress using broad eligibility criteria, and chosen for inclusion based on analysis of ISO22600. Cryptographic standards and methods were left outside the scope of this review. Three broad classes of models are being actively investigated and developed: access control for electronic health records, access control for interoperability, and access control for risk analysis. Traditional role-based access control models are extended with spatial, temporal, probabilistic, dynamic, and semantic aspects to capture contextual information and provide granular access control. Maintenance of audit trails and facilities for overriding normal roles to allow full access in emergency cases are common features. Access privilege frameworks utilizing ontology-based knowledge representation for defining the rules have attracted considerable interest, due to the higher level of abstraction that makes it possible to model domain knowledge and validate access requests efficiently.

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.

[Electronic versus paper-based patient records: a cost-benefit analysis].

PubMed

Neubauer, A S; Priglinger, S; Ehrt, O

2001-11-01

The aim of this study is to compare the costs and benefits of electronic, paperless patient records with the conventional paper-based charts. Costs and benefits of planned electronic patient records are calculated for a University eye hospital with 140 beds. Benefit is determined by direct costs saved by electronic records. In the example shown, the additional benefits of electronic patient records, as far as they can be quantified total 192,000 DM per year. The costs of the necessary investments are 234,000 DM per year when using a linear depreciation over 4 years. In total, there are additional annual costs for electronic patient records of 42,000 DM. Different scenarios were analyzed. By increasing the time of depreciation to 6 years, the cost deficit reduces to only approximately 9,000 DM. Increased wages reduce the deficit further while the deficit increases with a loss of functions of the electronic patient record. However, several benefits of electronic records regarding research, teaching, quality control and better data access cannot be easily quantified and would greatly increase the benefit to cost ratio. Only part of the advantages of electronic patient records can easily be quantified in terms of directly saved costs. The small cost deficit calculated in this example is overcompensated by several benefits, which can only be enumerated qualitatively due to problems in quantification.

Leveraging electronic health record documentation for Failure Mode and Effects Analysis team identification

PubMed Central

Carson, Matthew B; Lee, Young Ji; Benacka, Corrine; Mutharasan, R. Kannan; Ahmad, Faraz S; Kansal, Preeti; Yancy, Clyde W; Anderson, Allen S; Soulakis, Nicholas D

2017-01-01

Objective: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning. Methods: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation. Results: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation. Conclusion: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps. PMID:27589944

Characteristics of personal health records: findings of the Medical Library Association/National Library of Medicine Joint Electronic Personal Health Record Task Force.

PubMed

Jones, Dixie A; Shipman, Jean P; Plaut, Daphne A; Selden, Catherine R

2010-07-01

The Medical Library Association (MLA)/National Library of Medicine (NLM) Joint Electronic Personal Health Record Task Force examined the current state of personal health records (PHRs). A working definition of PHRs was formulated, and a database was built with fields for specified PHR characteristics. PHRs were identified and listed. Each task force member was assigned a portion of the list for data gathering. Findings were recorded in the database. Of the 117 PHRs identified, 91 were viable. Almost half were standalone products. A number used national standards for nomenclature and/or record structure. Less than half were mobile device enabled. Some were publicly available, and others were offered only to enrollees of particular health plans or employees at particular institutions. A few were targeted to special health conditions. The PHR field is very dynamic. While most PHR products have some common elements, their features can vary. PHRs can link their users with librarians and information resources. MLA and NLM have taken an active role in making this connection and in encouraging librarians to assume this assistance role with PHRs.

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.

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

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.

Merging Electronic Health Record Data and Genomics for Cardiovascular Research

PubMed Central

Hall, Jennifer L.; Ryan, John J.; Bray, Bruce E.; Brown, Candice; Lanfear, David; Newby, L. Kristin; Relling, Mary V.; Risch, Neil J.; Roden, Dan M.; Shaw, Stanley Y.; Tcheng, James E.; Tenenbaum, Jessica; Wang, Thomas N.; Weintraub, William S.

2017-01-01

The process of scientific discovery is rapidly evolving. The funding climate has influenced a favorable shift in scientific discovery toward the use of existing resources such as the electronic health record. The electronic health record enables long-term outlooks on human health and disease, in conjunction with multidimensional phenotypes that include laboratory data, images, vital signs, and other clinical information. Initial work has confirmed the utility of the electronic health record for understanding mechanisms and patterns of variability in disease susceptibility, disease evolution, and drug responses. The addition of biobanks and genomic data to the information contained in the electronic health record has been demonstrated. The purpose of this statement is to discuss the current challenges in and the potential for merging electronic health record data and genomics for cardiovascular research. PMID:26976545

Ethical, legal, and social implications of incorporating genomic information into electronic health records.

PubMed

Hazin, Ribhi; Brothers, Kyle B; Malin, Bradley A; Koenig, Barbara A; Sanderson, Saskia C; Rothstein, Mark A; Williams, Marc S; Clayton, Ellen W; Kullo, Iftikhar J

2013-10-01

The inclusion of genomic data in the electronic health record raises important ethical, legal, and social issues. In this article, we highlight these challenges and discuss potential solutions. We provide a brief background on the current state of electronic health records in the context of genomic medicine, discuss the importance of equitable access to genome-enabled electronic health records, and consider the potential use of electronic health records for improving genomic literacy in patients and providers. We highlight the importance of privacy, access, and security, and of determining which genomic information is included in the electronic health record. Finally, we discuss the challenges of reporting incidental findings, storing and reinterpreting genomic data, and nondocumentation and duty to warn family members at potential genetic risk.

76 FR 28791 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... participation for expenditures under their Medicaid Electronic Health Record Incentive Program related to health... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document... currently approved collection; Title of Information Collection: State Medicaid Health Information Technology...

12 CFR 1732.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... home computer systems of an employee; or (4) Whether the information is active or inactive. (k) Record... (e.g., e-mail, databases, spreadsheets, PowerPoint presentations, electronic reporting systems... information is stored or located, including network servers, desktop or laptop computers and handheld...

49 CFR 213.369 - Inspection records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... transfer records through electronic transmission, storage, and retrieval provided that— (1) The electronic... security such as recognition of an electronic signature, or other means, which uniquely identify the initiating person as the author of that record. No two persons shall have the same electronic identity; (2...

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

Women's health nursing in the context of the National Health Information Infrastructure.

PubMed

Jenkins, Melinda L; Hewitt, Caroline; Bakken, Suzanne

2006-01-01

Nurses must be prepared to participate in the evolving National Health Information Infrastructure and the changes that will consequently occur in health care practice and documentation. Informatics technologies will be used to develop electronic health records with integrated decision support features that will likely lead to enhanced health care quality and safety. This paper provides a summary of the National Health Information Infrastructure and highlights electronic health records and decision support systems within the context of evidence-based practice. Activities at the Columbia University School of Nursing designed to prepare nurses with the necessary informatics competencies to practice in a National Health Information Infrastructure-enabled health care system are described. Data are presented from electronic (personal digital assistant) encounter logs used in our Women's Health Nurse Practitioner program to support evidence-based advanced practice nursing care. Implications for nursing practice, education, and research in the evolving National Health Information Infrastructure are discussed.

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

PubMed

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

2017-06-01

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

32 CFR 518.7 - FOIA terms defined.

Code of Federal Regulations, 2013 CFR

2013-07-01

... books, papers, maps, photographs, and machine readable materials, inclusive of those in electronic form... create or compile a record to satisfy a FOIA request. (3) Hard copy or electronic records that are... conduct. (h) Electronic record. Records (including e-mail) that are created, stored, and retrievable by...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49...

49 CFR 228.205 - Access to electronic records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49...

Analysis of strong ionospheric scintillation events measured by means of GPS signals at low latitudes during disturbed conditions

NASA Astrophysics Data System (ADS)

Forte, B.

2012-08-01

Drifting structures characterized by inhomogeneities in the spatial electron density distribution at ionospheric heights cause the scintillation of radio waves propagating through. The fractional electron density fluctuations and the corresponding scintillation levels may reach extreme values at low latitudes during high solar activity. Different levels of scintillation were observed on experimental data collected in the Asian sector at low latitudes by means of a GPS dual frequency receiver under moderate solar activity (2005). The GPS receiver used in these campaigns was particularly modified in firmware in order to record power estimates on the C/A code as well as on the carriers L1 and L2. Strong scintillation activity was recorded in the post-sunset period (saturatingS4 and SI as high as 20 dB). Spectral modifications and broadening was observed during high levels of scintillation possibly indicating refractive scattering taking place instead of diffractive scattering. A possible interpretation of those events was attempted on the basis of the refractive scattering theory developed by Uscinski (1968) and Booker and MajidiAhi (1981).

Electronic health record use, intensity of hospital care, and patient outcomes.

PubMed

Blecker, Saul; Goldfeld, Keith; Park, Naeun; Shine, Daniel; Austrian, Jonathan S; Braithwaite, R Scott; Radford, Martha J; Gourevitch, Marc N

2014-03-01

Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity. Copyright © 2014 Elsevier Inc. All rights reserved.

The Future Is Coming: Electronic Health Records

MedlinePlus

... Current Issue Past Issues The Future Is Coming: Electronic Health Records Past Issues / Spring 2009 Table of ... special conference on the cutting-edge topic of electronic health records (EHR) on May 20-21, 2009, ...

Electronic recorder study

DOT National Transportation Integrated Search

1998-06-01

Information on the current use of electronic recorders and opinions on mandatory electronic recorder use was obtained from truck and bus fleets and owner operators through the cooperation of several trucking industry associations. Due to the low resp...

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

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

None

The Office of Legacy Management (LM) is an integral part of the U.S. Department of Energy’s (DOE’s) strategy to ensure that legacy liabilities of former nuclear weapons production sites are properly managed following the completion of environmental cleanup activities. LM will work with each site using an integrated team approach to ensure a successful transition. Part of this process will include transition of Government records and information. The Office of Legacy Management Information and Records Management Transition Guidance focuses on LM’s goal to preserve and protect legacy records and information. This guidance document establishes a framework for the transfer ofmore » records management responsibilities for sites transferring to LM. It describes the requirements, responsibilities, and procedures for the efficient and cost-effective transfer of custody, ownership, and management of records and other information products from the transfer site to LM. Records management practices are critical to the functions of Federal agencies because records provide information about, or evidence of, the organization, functions, policies, decisions, procedures, operations, or other activities. Therefore, the information generated by an agency is created, maintained, and dispositioned through records management processes that ensure the appropriate preservation and retrieval of essential information. Because of their intrinsic value, best practices to preserve information and records should be utilized when records are transferred from one organization to another. As the transfer program completes cleanup activities at closure sites, a transitional process will facilitate the transparent shift in the management of site records activities to LM. The roles and responsibilities of the transfer site and/or program and LM described in this document are a necessary foundation for cooperation and coordination and are essential to the successful transition of records and information responsibilities. The DOE Office of the Chief Information Officer (OCIO) has a central role in DOE records management by providing guidance, expertise, and coordination to all DOE offices and organizations and coordination with the National Archives and Records Administration (NARA). LM and the transfer site will complete an integrated transition plan which will integrate all transition elements including information and records. As part of the overall transition plan, an Information and Records Transition Plan will be developed consistent with the integrated transition plan for the site transfer and included as an attachment. The Information and Records Management Transition Plan will be developed to assist both organizations in organizing the tasks; establishing a timetable and milestones for their completion; and identifying manpower, funding and other resources that will be needed to complete the ownership transfer. In addition, the plan will provide a valuable exchange of institutional knowledge that will assist LM in meeting the obligations of responsibly managing legacy records. Guidance for the development of the plan is included in this document. Records management concerns that may arise during site closure, such as management support, contract language and agreements, interactions with the OCIO and NARA, resource and budget considerations, and procedures to safeguard records are addressed. Guidelines and criteria for records management transition activities are also provided. These include LM expectations for the inventory, scheduling, and disposition of records; the management and transfer of electronic files, including databases and software; records finding aids, indices, and recordkeeping systems; and the process for the transfer of hard copy and electronic records to LM.« less

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...

Antimicrobial drug use in Austrian pig farms: plausibility check of electronic on-farm records and estimation of consumption.

PubMed

Trauffler, M; Griesbacher, A; Fuchs, K; Köfer, J

2014-10-25

Electronic drug application records from farmers from 75 conventional pig farms were revised and checked for their plausibility. The registered drug amounts were verified by comparing the farmers' records with veterinarians' dispensary records. The antimicrobial consumption was evaluated from 2008 to 2011 and expressed in weight of active substance(s), number of used daily doses (nUDD), number of animal daily doses (nADD) and number of product-related daily doses (nPrDD). All results were referred to one year and animal bodyweight (kg biomass). The data plausibility proof revealed about 14 per cent of unrealistic drug amount entries in the farmers' records. The annual antimicrobial consumption was 33.9 mg/kg/year, 4.9 UDDkg/kg/year, 1.9 ADDkg/kg/year and 2.5 PrDDkg/kg/year (average). Most of the antimicrobials were applied orally (86 per cent) and at group-level. Main therapy indications were metaphylactic/prophylactic measures (farrow-to-finish and fattening farms) or digestive tract diseases (breeding farms). The proportion of the 'highest priority critically important antimicrobials' was low (12 per cent). After determination of a threshold value, farms with a high antimicrobial use could be detected. Statistical tests showed that the veterinarian had an influence on the dosage, the therapy indication and the active substance. Orally administered antimicrobials were mostly underdosed, parenterally administered antimicrobials rather correctly or overdosed. British Veterinary Association.

Direct imaging detectors for electron microscopy

NASA Astrophysics Data System (ADS)

Faruqi, A. R.; McMullan, G.

2018-01-01

Electronic detectors used for imaging in electron microscopy are reviewed in this paper. Much of the detector technology is based on the developments in microelectronics, which have allowed the design of direct detectors with fine pixels, fast readout and which are sufficiently radiation hard for practical use. Detectors included in this review are hybrid pixel detectors, monolithic active pixel sensors based on CMOS technology and pnCCDs, which share one important feature: they are all direct imaging detectors, relying on directly converting energy in a semiconductor. Traditional methods of recording images in the electron microscope such as film and CCDs, are mentioned briefly along with a more detailed description of direct electronic detectors. Many applications benefit from the use of direct electron detectors and a few examples are mentioned in the text. In recent years one of the most dramatic advances in structural biology has been in the deployment of the new backthinned CMOS direct detectors to attain near-atomic resolution molecular structures with electron cryo-microscopy (cryo-EM). The development of direct detectors, along with a number of other parallel advances, has seen a very significant amount of new information being recorded in the images, which was not previously possible-and this forms the main emphasis of the review.

Simultaneous transcranial magnetic stimulation and single neuron recording in alert non-human primates

PubMed Central

Mueller, Jerel K.; Grigsby, Erinn M.; Prevosto, Vincent; Petraglia, Frank W.; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V.; Sommer, Marc A.; Egner, Tobias; Platt, Michael L.; Grill, Warren M.

2014-01-01

Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report novel methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally perturbed by stimulation artifact in intact, awake monkeys (Macaca mulatta). We recorded action potentials within ~1 ms after 0.4 ms TMS pulses and observed changes in activity that differed significantly for active stimulation as compared to sham stimulation. The methodology is compatible with standard equipment in primate laboratories, allowing for easy implementation. Application of these new tools will facilitate the refinement of next generation TMS devices, experiments, and treatment protocols. PMID:24974797

Closed-loop optical neural stimulation based on a 32-channel low-noise recording system with online spike sorting

NASA Astrophysics Data System (ADS)

Nguyen, T. K. T.; Navratilova, Z.; Cabral, H.; Wang, L.; Gielen, G.; Battaglia, F. P.; Bartic, C.

2014-08-01

Objective. Closed-loop operation of neuro-electronic systems is desirable for both scientific and clinical (neuroprosthesis) applications. Integrating optical stimulation with recording capability further enhances the selectivity of neural stimulation. We have developed a system enabling the local delivery of optical stimuli and the simultaneous electrical measuring of the neural activities in a closed-loop approach. Approach. The signal analysis is performed online through the implementation of a template matching algorithm. The system performance is demonstrated with the recorded data and in awake rats. Main results. Specifically, the neural activities are simultaneously recorded, detected, classified online (through spike sorting) from 32 channels, and used to trigger a light emitting diode light source using generated TTL signals. Significance. A total processing time of 8 ms is achieved, suitable for optogenetic studies of brain mechanisms online.

36 CFR § 1226.24 - How must agencies destroy temporary records?

Code of Federal Regulations, 2013 CFR

2013-07-01

... records or documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and... RECORDS ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy...

Engineered hybrid cardiac patches with multifunctional electronics for online monitoring and regulation of tissue function

PubMed Central

Feiner, Ron; Engel, Leeya; Fleischer, Sharon; Malki, Maayan; Gal, Idan; Shapira, Assaf; Shacham-Diamand, Yosi; Dvir, Tal

2016-01-01

In cardiac tissue engineering approaches to treat myocardial infarction, cardiac cells are seeded within three-dimensional porous scaffolds to create functional cardiac patches. However, current cardiac patches do not allow for online monitoring and reporting of engineered-tissue performance, and do not interfere to deliver signals for patch activation or to enable its integration with the host. Here, we report an engineered cardiac patch that integrates cardiac cells with flexible, free-standing electronics and a 3D nanocomposite scaffold. The patch exhibited robust electronic properties, enabling the recording of cellular electrical activities and the on-demand provision of electrical stimulation for synchronizing cell contraction. We also show that electroactive polymers containing biological factors can be deposited on designated electrodes to release drugs in the patch microenvironment on-demand. We expect that the integration of complex electronics within cardiac patches will eventually provide therapeutic control and regulation of cardiac function. PMID:26974408

Engineered hybrid cardiac patches with multifunctional electronics for online monitoring and regulation of tissue function.

PubMed

Feiner, Ron; Engel, Leeya; Fleischer, Sharon; Malki, Maayan; Gal, Idan; Shapira, Assaf; Shacham-Diamand, Yosi; Dvir, Tal

2016-06-01

In cardiac tissue engineering approaches to treat myocardial infarction, cardiac cells are seeded within three-dimensional porous scaffolds to create functional cardiac patches. However, current cardiac patches do not allow for online monitoring and reporting of engineered-tissue performance, and do not interfere to deliver signals for patch activation or to enable its integration with the host. Here, we report an engineered cardiac patch that integrates cardiac cells with flexible, freestanding electronics and a 3D nanocomposite scaffold. The patch exhibited robust electronic properties, enabling the recording of cellular electrical activities and the on-demand provision of electrical stimulation for synchronizing cell contraction. We also show that electroactive polymers containing biological factors can be deposited on designated electrodes to release drugs in the patch microenvironment on demand. We expect that the integration of complex electronics within cardiac patches will eventually provide therapeutic control and regulation of cardiac function.

Doctors' use of electronic medical records systems in hospitals: cross sectional survey

PubMed Central

Lærum, Hallvard; Ellingsen, Gunnar; Faxvaag, Arild

2001-01-01

Objectives To compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks. Design Cross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems. Setting 32 hospital units in 19 Norwegian hospitals with electronic medical records systems. Participants 227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems. Main outcome measures Proportion of respondents who used the electronic system, calculated for each of 23 tasks; difference in proportions of users of different systems when functionality of systems was similar. Results Most tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems. Conclusions Doctors used electronic medical records systems for far fewer tasks than the systems supported. What is already known on this topicElectronic information systems in health care have not undergone systematic evaluation, and few comparisons between electronic medical records systems have been madeGiven the information intensive nature of clinical work, electronic medical records systems should be of help to doctors for most clinical tasksWhat this study addsDoctors in Norwegian hospitals reported a low level of use of all electronic medical records systemsThe systems were mainly used for reading patient data, and doctors used the systems for less than half of the tasks for which the systems were functionalAnalyses of actual use of electronic medical records provide more information than user satisfaction or functionality of such records systems PMID:11739222

The ImmProve Project: Leveraging electronic health record data to promote immunization delivery

PubMed Central

Bundy, David G.; Persing, Nichole M.; Solomon, Barry S.; King, Tracy M.; Murakami, Peter; Thompson, Richard E.; Engineer, Lilly D.; Lehmann, Christoph U.; Miller, Marlene R.

2013-01-01

Objective Though an essential pediatric preventive service, immunizations are challenging to deliver reliably. Our objective was to measure the impact on pediatric immunization rates of providing clinicians with electronic health record-derived immunization prompting. Methods Operating in a large, urban, hospital-based pediatric primary care clinic, we evaluated 2 interventions to improve immunization delivery to children ages 2, 6, and 13 years: point-of-care, patient-specific electronic clinical decision support (CDS) when children overdue for immunizations presented for care and provider-specific bulletins listing children overdue for immunizations. Results Overall, the proportion of children up-to-date for a composite of recommended immunizations at ages 2, 6, and 13 years was not different in the intervention (CDS active) and historical control (CDS not active) periods; historical immunization rates were high. The proportion of children receiving 2 doses of hepatitis A immunization prior to their second birthday was significantly improved during the intervention period. Human papilloma virus (HPV) immunization delivery was low during both control and intervention periods and was unchanged for 13-year-olds. For 14-year-olds, however, 4 of the 5 highest quarterly rates of complete HPV immunization occurred in the final year of the intervention. Provider-specific bulletins listing children overdue for immunizations increased the likelihood of identified children receiving catch-up hepatitis A immunizations (hazard ratio: 1.32 [95% confidence interval (CI): 1.12–1.56]); results for HPV and the composite of recommended immunizations were of a similar magnitude but not statistically significant. Conclusions In our patient population, with high baseline uptake of recommended immunizations, electronic health record-derived immunization prompting had a limited effect on immunization delivery. Benefit was more clearly demonstrated for newer immunizations with lower baseline uptake. PMID:23726754

Improving immunization delivery using an electronic health record: the ImmProve project.

PubMed

Bundy, David G; Persing, Nichole M; Solomon, Barry S; King, Tracy M; Murakami, Peter N; Thompson, Richard E; Engineer, Lilly D; Lehmann, Christoph U; Miller, Marlene R

2013-01-01

Though an essential pediatric preventive service, immunizations are challenging to deliver reliably. Our objective was to measure the impact on pediatric immunization rates of providing clinicians with electronic health record-derived immunization prompting. Operating in a large, urban, hospital-based pediatric primary care clinic, we evaluated 2 interventions to improve immunization delivery to children ages 2, 6, and 13 years: point-of-care, patient-specific electronic clinical decision support (CDS) when children overdue for immunizations presented for care, and provider-specific bulletins listing children overdue for immunizations. Overall, the proportion of children up to date for a composite of recommended immunizations at ages 2, 6, and 13 years was not different in the intervention (CDS active) and historical control (CDS not active) periods; historical immunization rates were high. The proportion of children receiving 2 doses of hepatitis A immunization before their second birthday was significantly improved during the intervention period. Human papillomavirus (HPV) immunization delivery was low during both control and intervention periods and was unchanged for 13-year-olds. For 14-year-olds, however, 4 of the 5 highest quarterly rates of complete HPV immunization occurred in the final year of the intervention. Provider-specific bulletins listing children overdue for immunizations increased the likelihood of identified children receiving catch-up hepatitis A immunizations (hazard ratio 1.32; 95% confidence interval 1.12-1.56); results for HPV and the composite of recommended immunizations were of a similar magnitude but not statistically significant. In our patient population, with high baseline uptake of recommended immunizations, electronic health record-derived immunization prompting had a limited effect on immunization delivery. Benefit was more clearly demonstrated for newer immunizations with lower baseline uptake. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Ethics of Implementing Electronic Health Records in Developing Countries: Points to Consider

PubMed Central

Were, Martin C.; Meslin, Eric M.

2011-01-01

Electronic Health Record systems (EHRs) are increasingly being used in many developing countries, several of which have moved beyond isolated pilot projects to active large-scale implementation as part of their national health strategies. Despite growing enthusiasm for adopting EHRs in resource poor settings, almost no attention has been paid to the ethical issues that might arise. In this article we argue that these ethical issues should be addressed now if EHRs are to be appropriately implemented in these settings. We take a systematic approach guided by a widely accepted ethical framework currently in use for developing countries to first describe the ethical issues, and then propose a set of ‘Points to Consider’ to guide further thinking and decision-making. PMID:22195214

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.

Emergency Physician Task Switching Increases With the Introduction of a Commercial Electronic Health Record.

PubMed

Benda, Natalie C; Meadors, Margaret L; Hettinger, A Zachary; Ratwani, Raj M

2016-06-01

We evaluate how the transition from a homegrown electronic health record to a commercial one affects emergency physician work activities from initial introduction to long-term use. We completed a quasi-experimental study across 3 periods during the transition from a homegrown system to a commercially available electronic health record with computerized provider order entry. Observation periods consisted of pre-implementation, 1 month before the implementation of the commercial electronic health record; "go-live" 1 week after implementation; and post-implementation, 3 to 4 months after use began. Fourteen physicians were observed in each period (N=42) with a minute-by-minute observation template to record emergency physician time allocation across 5 task-based categories (computer, verbal communication, patient room, paper [chart/laboratory results], and other). The average number of tasks physicians engaged in per minute was also analyzed as an indicator of task switching. From pre- to post-implementation, there were no significant differences in the amount of time spent on the various task categories. There were changes in time allocation from pre-implementation to go-live and go-live to pre-implementation, characterized by a significant increase in time spent on computer tasks during go-live relative to the other periods. Critically, the number of tasks physicians engaged in per minute increased from 1.7 during pre-implementation to 1.9 during post-implementation (difference 0.19 tasks per minute; 95% confidence interval 0.039 to 0.35). The increase in the number of tasks physicians engaged in per minute post-implementation indicates that physicians switched tasks more frequently. Frequent task switching behavior raises patient safety concerns. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Personal, Electronic, Secure National Library of Medicine Hosts Health Records Conference

MedlinePlus

... Bar Home Current Issue Past Issues EHR Personal, Electronic, Secure: National Library of Medicine Hosts Health Records ... One suggestion for saving money is to implement electronic personal health records. With this in mind, the ...

Electronic Health Records Place 1st at Indy 500

MedlinePlus

... Navigation Bar Home Current Issue Past Issues EHR Electronic Health Records Place 1st at Indy 500 Past ... last May's Indy 500 had thousands of personal Electronic Health Records on hand for those attending—and ...

Electronic Health Records: VAs Efforts Raise Concerns about Interoperability Goals and Measures, Duplication with DOD, and Future Plans

DTIC Science & Technology

2016-07-13

ELECTRONIC HEALTH RECORDS VA’s Efforts Raise Concerns about Interoperability Goals and Measures, Duplication with DOD...Agencies, Committee on Appropriations, U.S. Senate July 13, 2016 ELECTRONIC HEALTH RECORDS VA’s Efforts Raise Concerns about Interoperability Goals...initiatives with the Department of Defense (DOD) that were intended to advance the ability of the two departments to share electronic health records , the

Merging Electronic Health Record Data and Genomics for Cardiovascular Research: A Science Advisory From the American Heart Association.

PubMed

Hall, Jennifer L; Ryan, John J; Bray, Bruce E; Brown, Candice; Lanfear, David; Newby, L Kristin; Relling, Mary V; Risch, Neil J; Roden, Dan M; Shaw, Stanley Y; Tcheng, James E; Tenenbaum, Jessica; Wang, Thomas N; Weintraub, William S

2016-04-01

The process of scientific discovery is rapidly evolving. The funding climate has influenced a favorable shift in scientific discovery toward the use of existing resources such as the electronic health record. The electronic health record enables long-term outlooks on human health and disease, in conjunction with multidimensional phenotypes that include laboratory data, images, vital signs, and other clinical information. Initial work has confirmed the utility of the electronic health record for understanding mechanisms and patterns of variability in disease susceptibility, disease evolution, and drug responses. The addition of biobanks and genomic data to the information contained in the electronic health record has been demonstrated. The purpose of this statement is to discuss the current challenges in and the potential for merging electronic health record data and genomics for cardiovascular research. © 2016 American Heart Association, Inc.

CTEPP STANDARD OPERATING PROCEDURE FOR MAINTAINING AND RECORDING ELECTRONIC CHAIN-OF-CUSTODY (SOP-4.11)

EPA Science Inventory

The method for maintaining and recording electronic Chain-of-Custody (CoC) Records for CTEPP samples is summarized in this SOP. The CoC Records that will be logged electronically include the creation of a sample's identification code, bar code labels, and hard-copy CoC document...

Intraoperative non-record-keeping usage of anesthesia information management system workstations and associated hemodynamic variability and aberrancies.

PubMed

Wax, David B; Lin, Hung-Mo; Reich, David L

2012-12-01

Anesthesia information management system workstations in the anesthesia workspace that allow usage of non-record-keeping applications could lead to distraction from patient care. We evaluated whether non-record-keeping usage of the computer workstation was associated with hemodynamic variability and aberrancies. Auditing data were collected on eight anesthesia information management system workstations and linked to their corresponding electronic anesthesia records to identify which application was active at any given time during the case. For each case, the periods spent using the anesthesia information management system record-keeping module were separated from those spent using non-record-keeping applications. The variability of heart rate and blood pressure were also calculated, as were the incidence of hypotension, hypertension, and tachycardia. Analysis was performed to identify whether non-record-keeping activity was a significant predictor of these hemodynamic outcomes. Data were analyzed for 1,061 cases performed by 171 clinicians. Median (interquartile range) non-record-keeping activity time was 14 (1, 38) min, representing 16 (3, 33)% of a median 80 (39, 143) min of procedure time. Variables associated with greater non-record-keeping activity included attending anesthesiologists working unassisted, longer case duration, lower American Society of Anesthesiologists status, and general anesthesia. Overall, there was no independent association between non-record-keeping workstation use and hemodynamic variability or aberrancies during anesthesia either between cases or within cases. Anesthesia providers spent sizable portions of case time performing non-record-keeping applications on anesthesia information management system workstations. This use, however, was not independently associated with greater hemodynamic variability or aberrancies in patients during maintenance of general anesthesia for predominantly general surgical and gynecologic procedures.

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

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

PubMed

Lartigue, B; Catillon, E

2012-02-01

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

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

PubMed

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

2011-07-01

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

A personally controlled electronic health record for Australia

PubMed Central

Pearce, Christopher; Bainbridge, Michael

2014-01-01

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

The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

PubMed

Rodriguez Torres, Yasaira; Huang, Jordan; Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi; Hwang, Frank S

2017-01-01

This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p < 0.0005). Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

36 CFR 1226.24 - How must agencies destroy temporary records?

Code of Federal Regulations, 2010 CFR

2010-07-01

... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

36 CFR 1226.24 - How must agencies destroy temporary records?

Code of Federal Regulations, 2012 CFR

2012-07-01

... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

36 CFR 1226.24 - How must agencies destroy temporary records?

Code of Federal Regulations, 2011 CFR

2011-07-01

... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

36 CFR 1226.24 - How must agencies destroy temporary records?

Code of Federal Regulations, 2014 CFR

2014-07-01

... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

Data-driven approach for creating synthetic electronic medical records.

PubMed

Buczak, Anna L; Babin, Steven; Moniz, Linda

2010-10-14

New algorithms for disease outbreak detection are being developed to take advantage of full electronic medical records (EMRs) that contain a wealth of patient information. However, due to privacy concerns, even anonymized EMRs cannot be shared among researchers, resulting in great difficulty in comparing the effectiveness of these algorithms. To bridge the gap between novel bio-surveillance algorithms operating on full EMRs and the lack of non-identifiable EMR data, a method for generating complete and synthetic EMRs was developed. This paper describes a novel methodology for generating complete synthetic EMRs both for an outbreak illness of interest (tularemia) and for background records. The method developed has three major steps: 1) synthetic patient identity and basic information generation; 2) identification of care patterns that the synthetic patients would receive based on the information present in real EMR data for similar health problems; 3) adaptation of these care patterns to the synthetic patient population. We generated EMRs, including visit records, clinical activity, laboratory orders/results and radiology orders/results for 203 synthetic tularemia outbreak patients. Validation of the records by a medical expert revealed problems in 19% of the records; these were subsequently corrected. We also generated background EMRs for over 3000 patients in the 4-11 yr age group. Validation of those records by a medical expert revealed problems in fewer than 3% of these background patient EMRs and the errors were subsequently rectified. A data-driven method was developed for generating fully synthetic EMRs. The method is general and can be applied to any data set that has similar data elements (such as laboratory and radiology orders and results, clinical activity, prescription orders). The pilot synthetic outbreak records were for tularemia but our approach may be adapted to other infectious diseases. The pilot synthetic background records were in the 4-11 year old age group. The adaptations that must be made to the algorithms to produce synthetic background EMRs for other age groups are indicated.

75 FR 71081 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-22

... effective without further notice on December 22, 2010 unless comments are received which result in a... birth, gender, current status (actively employed or retired), Social Security Numbers (SSN), ethnicity...: Storage: Electronic storage media. Retrievability: Retrieved by the employee using a unique username and...

76 FR 47592 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-05

... Federal financial participation for expenditures under their Medicaid Electronic Health Record Incentive... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document...), Department of Health and Human Services, is publishing the following summary of proposed collections for...

75 FR 65354 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... of information technology to minimize the information collection burden. 1. Type of Information... information technology (HIT) and certified electronic health records (EHRs) will improve the quality and value... for Health Information Technology (ONC). The functionality of certified EHR technology should...

75 FR 12573 - Advisory Committee on the Electronic Records Archives (ACERA)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National Archives and Records Administration. ACTION: Notice of meeting. SUMMARY: In... and Records Administration (NARA) announces a [[Page 12574

Electronic Collection and Dissemination of Information by Federal Agencies. Hearings before a Subcommittee of the Committee on Government Operations, House of Representatives, Ninety-Ninth Congress, First Session (April 29, June 26, October 18, 1985).

ERIC Educational Resources Information Center

Congress of the U. S., Washington, DC. House Committee on Government Operations.

This document provides a complete record of testimony presented at a series of hearings before the U.S. Congress on the electronic collection and dissemination of information by federal agencies. In looking at the effect of new computer and communications technology on government information activities and practices, the hearings considered such…

Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

PubMed

Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

2009-10-08

Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support

PubMed Central

2009-01-01

Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment. PMID:19814826

PhotoMEA: an opto-electronic biosensor for monitoring in vitro neuronal network activity.

PubMed

Ghezzi, Diego; Pedrocchi, Alessandra; Menegon, Andrea; Mantero, Sara; Valtorta, Flavia; Ferrigno, Giancarlo

2007-02-01

PhotoMEA is a biosensor useful for the analysis of an in vitro neuronal network, fully based on optical methods. Its function is based on the stimulation of neurons with caged glutamate and the recording of neuronal activity by Voltage-Sensitive fluorescent Dyes (VSD). The main advantage is that it will be possible to stimulate even at sub-single neuron level and to record with high resolution the activity of the entire network in the culture. A large-scale view of neuronal intercommunications offers a unique opportunity for testing the ability of drugs to affect neuronal properties as well as alterations in the behaviour of the entire network. The concept and a prototype for validation is described here in detail.

[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.

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.

The need for academic electronic health record systems in nurse education.

PubMed

Chung, Joohyun; Cho, Insook

2017-07-01

The nursing profession has been slow to incorporate information technology into formal nurse education and practice. The aim of this study was to identify the use of academic electronic health record systems in nurse education and to determine student and faculty perceptions of academic electronic health record systems in nurse education. A quantitative research design with supportive qualitative research was used to gather information on nursing students' perceptions and nursing faculty's perceptions of academic electronic health record systems in nurse education. Eighty-three participants (21 nursing faculty and 62 students), from 5 nursing schools, participated in the study. A purposive sample of 9 nursing faculty was recruited from one university in the Midwestern United States to provide qualitative data for the study. The researcher-designed surveys (completed by faculty and students) were used for quantitative data collection. Qualitative data was taken from interviews, which were transcribed verbatim for analysis. Students and faculty agreed that academic electronic health record systems could be useful for teaching students to think critically about nursing documentation. Quantitative and qualitative findings revealed that academic electronic health record systems regarding nursing documentation could help prepare students for the future of health information technology. Meaningful adoption of academic electronic health record systems will help in building the undergraduate nursing students' competence in nursing documentation with electronic health record systems. Copyright © 2017. Published by Elsevier Ltd.

75 FR 63434 - Availability of Compliance Guide for the Use of Video or Other Electronic Monitoring or Recording...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

...] Availability of Compliance Guide for the Use of Video or Other Electronic Monitoring or Recording Equipment in... the availability of a compliance guide on the use of video or other electronic monitoring or recording... Procedures video records. FSIS is soliciting comments on this compliance guide. Once FSIS receives OMB...

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.

The Homemade Alternative: Teaching Human Neurophysiology with Instrumentation Made (Almost) from Scratch

PubMed Central

Hauptman, Stephen; Du Bois, Katherine; Johnson, Bruce R.

2012-01-01

Recording human neurophysiological data in the teaching laboratory generally requires expensive instrumentation. From our experience in developing inexpensive equipment used in teaching neurophysiology laboratory exercises, we offer a strategy for the development of affordable and safe recording of human neurophysiological parameters. There are many resources available to guide the design and construction of electronic equipment that will record human biopotentials. An important consideration is subject safety, and the electrical characteristics of any equipment must meet strict galvanic isolation standards. Wireless data gathering offers the most complete isolation from 120VAC current. As an example, we present a homemade electrocardiogram recording circuit using only inexpensive and readily available components. We outline the feasibility of constructing equipment that meets the needs of the student laboratory for good data collection, and we consider the obstacles likely to be encountered in these projects. If students actively participate in the equipment design and construction, the process can also be a teaching tool. Students may gain a deeper understanding of the human neurobiology by making the electronic data acquisition and its presentation more transparent. PMID:23493343

Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research.

PubMed

Wu, Albert W; Kharrazi, Hadi; Boulware, L Ebony; Snyder, Claire F

2013-08-01

This article presents the current state of patient-reported outcome measures and explains new opportunities for leveraging the recent adoption of electronic health records to expand the application of patient-reported outcomes in both clinical care and comparative effectiveness research. Historic developments of patient-reported outcome, electronic health record, and comparative effectiveness research are analyzed in two dimensions: patient centeredness and digitization. We pose the question, "What needs to be standardized around the collection of patient-reported outcomes in electronic health records for comparative effectiveness research?" We identified three converging trends: the progression of patient-reported outcomes toward greater patient centeredness and electronic adaptation; the evolution of electronic health records into personalized and fully digitized solutions; and the shift toward patient-oriented comparative effectiveness research. Related to this convergence, we propose an architecture for patient-reported outcome standardization that could serve as a first step toward a more comprehensive integration of patient-reported outcomes with electronic health record for both practice and research. The science of patient-reported outcome measurement has matured sufficiently to be integrated routinely into electronic health records and other electronic health solutions to collect data on an ongoing basis for clinical care and comparative effectiveness research. Further efforts and ideally coordinated efforts from various stakeholders are needed to refine the details of the proposed framework for standardization. Copyright © 2013 Elsevier Inc. All rights reserved.

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.

21 CFR 1002.30 - Records to be maintained by manufacturers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Manufacturers' Records § 1002.30 Records to be maintained... procedures with respect to electronic product radiation safety. (2) Records of the results of tests for... increase electronic product radiation emission, records of the results of tests for durability and...

Quality of routine health data collected by health workers using smartphone at primary health care in Ethiopia.

PubMed

Medhanyie, Araya Abrha; Spigt, Mark; Yebyo, Henock; Little, Alex; Tadesse, Kidane; Dinant, Geert-Jan; Blanco, Roman

2017-05-01

Mobile phone based applications are considered by many as potentially useful for addressing challenges and improving the quality of data collection in developing countries. Yet very little evidence is available supporting or refuting the potential and widely perceived benefits on the use of electronic forms on smartphones for routine patient data collection by health workers at primary health care facilities. A facility based cross sectional study using a structured paper checklist was prepared to assess the completeness and accuracy of 408 electronic records completed and submitted to a central database server using electronic forms on smartphones by 25 health workers. The 408 electronic records were selected randomly out of a total of 1772 maternal health records submitted by the health workers to the central database over a period of six months. Descriptive frequencies and percentages of data completeness and error rates were calculated. When compared to paper records, the use of electronic forms significantly improved data completeness by 209 (8%) entries. Of a total 2622 entries checked for completeness, 2602 (99.2%) electronic record entries were complete, while 2393 (91.3%) paper record entries were complete. A very small percentage of error rates, which was easily identifiable, occurred in both electronic and paper forms although the error rate in the electronic records was more than double that of paper records (2.8% vs. 1.1%). More than half of entry errors in the electronic records related to entering a text value. With minimal training, supervision, and no incentives, health care workers were able to use electronic forms for patient assessment and routine data collection appropriately and accurately with a very small error rate. Minimising the number of questions requiring text responses in electronic forms would be helpful in minimizing data errors. Copyright © 2017 Elsevier B.V. All rights reserved.

Tales of the Tape

ERIC Educational Resources Information Center

Glenn, David

2006-01-01

Research psychologists at the University of Texas are using electronically activated recorders (EARs) to study a range of human behavior, including romantic couples' dynamics, cross-cultural variations in sociability, and how students coped after the 9/11 attacks. The EAR studies, although still in their relative infancy, are generating striking…

77 FR 4041 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-26

... Healthcare Research and Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve the proposed information collection project: ``Assessing the Feasibility of Disseminating Effective Health Care Products through a Shared Electronic Medical Record Serving Member Organization of a Health Information...

78 FR 34387 - Agency Information Collection Activities; Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

... Facility Survey CMS-3070--Intermediate Care Facility (ICF) for the Mentally Retarded (MR) or Persons with Related Conditions Survey Report Form CMS-10336--Medicare and Medicaid Programs: Electronic Health Record... Renal Disease (ESRD) Medical Information Facility Survey; Use: The End Stage Renal Disease (ESRD...

78 FR 49516 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... experiment with and evaluate several promising ideas related to improving the quality of children's health... evaluate the impact of a model pediatric electronic health record. Category E grantees are testing other... descriptive and inferential techniques appropriate to answering questions about outcomes and impacts...

42 CFR 495.342 - Annual HIT IAPD requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... delays in meeting target dates in the approved HIT technology PAPD/IAPD and approved changes to it. (c) A... products. (d) A project activity schedule for the remainder of the project. (e) A project expenditure...

42 CFR 495.342 - Annual HIT IAPD requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE... delays in meeting target dates in the approved HIT technology PAPD/IAPD and approved changes to it. (c) A... products. (d) A project activity schedule for the remainder of the project. (e) A project expenditure...

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.

Single Molecule Bioelectronics and Their Application to Amplification-Free Measurement of DNA Lengths

PubMed Central

Gül, O. Tolga; Pugliese, Kaitlin M.; Choi, Yongki; Sims, Patrick C.; Pan, Deng; Rajapakse, Arith J.; Weiss, Gregory A.; Collins, Philip G.

2016-01-01

As biosensing devices shrink smaller and smaller, they approach a scale in which single molecule electronic sensing becomes possible. Here, we review the operation of single-enzyme transistors made using single-walled carbon nanotubes. These novel hybrid devices transduce the motions and catalytic activity of a single protein into an electronic signal for real-time monitoring of the protein’s activity. Analysis of these electronic signals reveals new insights into enzyme function and proves the electronic technique to be complementary to other single-molecule methods based on fluorescence. As one example of the nanocircuit technique, we have studied the Klenow Fragment (KF) of DNA polymerase I as it catalytically processes single-stranded DNA templates. The fidelity of DNA polymerases makes them a key component in many DNA sequencing techniques, and here we demonstrate that KF nanocircuits readily resolve DNA polymerization with single-base sensitivity. Consequently, template lengths can be directly counted from electronic recordings of KF’s base-by-base activity. After measuring as few as 20 copies, the template length can be determined with <1 base pair resolution, and different template lengths can be identified and enumerated in solutions containing template mixtures. PMID:27348011

Single Molecule Bioelectronics and Their Application to Amplification-Free Measurement of DNA Lengths.

PubMed

Gül, O Tolga; Pugliese, Kaitlin M; Choi, Yongki; Sims, Patrick C; Pan, Deng; Rajapakse, Arith J; Weiss, Gregory A; Collins, Philip G

2016-06-24

As biosensing devices shrink smaller and smaller, they approach a scale in which single molecule electronic sensing becomes possible. Here, we review the operation of single-enzyme transistors made using single-walled carbon nanotubes. These novel hybrid devices transduce the motions and catalytic activity of a single protein into an electronic signal for real-time monitoring of the protein's activity. Analysis of these electronic signals reveals new insights into enzyme function and proves the electronic technique to be complementary to other single-molecule methods based on fluorescence. As one example of the nanocircuit technique, we have studied the Klenow Fragment (KF) of DNA polymerase I as it catalytically processes single-stranded DNA templates. The fidelity of DNA polymerases makes them a key component in many DNA sequencing techniques, and here we demonstrate that KF nanocircuits readily resolve DNA polymerization with single-base sensitivity. Consequently, template lengths can be directly counted from electronic recordings of KF's base-by-base activity. After measuring as few as 20 copies, the template length can be determined with <1 base pair resolution, and different template lengths can be identified and enumerated in solutions containing template mixtures.

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

Nanoelectronics-biology frontier: From nanoscopic probes for action potential recording in live cells to three-dimensional cyborg tissues.

PubMed

Duan, Xiaojie; Fu, Tian-Ming; Liu, Jia; Lieber, Charles M

2013-08-01

Semiconductor nanowires configured as the active channels of field-effect transistors (FETs) have been used as detectors for high-resolution electrical recording from single live cells, cell networks, tissues and organs. Extracellular measurements with substrate supported silicon nanowire (SiNW) FETs, which have projected active areas orders of magnitude smaller than conventional microfabricated multielectrode arrays (MEAs) and planar FETs, recorded action potential and field potential signals with high signal-to-noise ratio and temporal resolution from cultured neurons, cultured cardiomyocytes, acute brain slices and whole animal hearts. Measurements made with modulation-doped nanoscale active channel SiNW FETs demonstrate that signals recorded from cardiomyocytes are highly localized and have improved time resolution compared to larger planar detectors. In addition, several novel three-dimensional (3D) transistor probes, which were realized using advanced nanowire synthesis methods, have been implemented for intracellular recording. These novel probes include (i) flexible 3D kinked nanowire FETs, (ii) branched intracellular nanotube SiNW FETs, and (iii) active silicon nanotube FETs. Following phospholipid modification of the probes to mimic the cell membrane, the kinked nanowire, branched intracellular nanotube and active silicon nanotube FET probes recorded full-amplitude intracellular action potentials from spontaneously firing cardiomyocytes. Moreover, these probes demonstrated the capability of reversible, stable, and long-term intracellular recording, thus indicating the minimal invasiveness of the new nanoscale structures and suggesting biomimetic internalization via the phospholipid modification. Simultaneous, multi-site intracellular recording from both single cells and cell networks were also readily achieved by interfacing independently addressable nanoprobe devices with cells. Finally, electronic and biological systems have been seamlessly merged in 3D for the first time using macroporous nanoelectronic scaffolds that are analogous to synthetic tissue scaffold and the extracellular matrix in tissue. Free-standing 3D nanoelectronic scaffolds were cultured with neurons, cardiomyocytes and smooth muscle cells to yield electronically-innervated synthetic or 'cyborg' tissues. Measurements demonstrate that innervated tissues exhibit similar cell viability as with conventional tissue scaffolds, and importantly, demonstrate that the real-time response to drugs and pH changes can be mapped in 3D through the tissues. These results open up a new field of research, wherein nanoelectronics are merged with biological systems in 3D thereby providing broad opportunities, ranging from a nanoelectronic/tissue platform for real-time pharmacological screening in 3D to implantable 'cyborg' tissues enabling closed-loop monitoring and treatment of diseases. Furthermore, the capability of high density scale-up of the above extra- and intracellular nanoscopic probes for action potential recording provide important tools for large-scale high spatio-temporal resolution electrical neural activity mapping in both 2D and 3D, which promises to have a profound impact on many research areas, including the mapping of activity within the brain.

Nanoelectronics-biology frontier: From nanoscopic probes for action potential recording in live cells to three-dimensional cyborg tissues

PubMed Central

Duan, Xiaojie; Fu, Tian-Ming; Liu, Jia; Lieber, Charles M.

2013-01-01

Summary Semiconductor nanowires configured as the active channels of field-effect transistors (FETs) have been used as detectors for high-resolution electrical recording from single live cells, cell networks, tissues and organs. Extracellular measurements with substrate supported silicon nanowire (SiNW) FETs, which have projected active areas orders of magnitude smaller than conventional microfabricated multielectrode arrays (MEAs) and planar FETs, recorded action potential and field potential signals with high signal-to-noise ratio and temporal resolution from cultured neurons, cultured cardiomyocytes, acute brain slices and whole animal hearts. Measurements made with modulation-doped nanoscale active channel SiNW FETs demonstrate that signals recorded from cardiomyocytes are highly localized and have improved time resolution compared to larger planar detectors. In addition, several novel three-dimensional (3D) transistor probes, which were realized using advanced nanowire synthesis methods, have been implemented for intracellular recording. These novel probes include (i) flexible 3D kinked nanowire FETs, (ii) branched intracellular nanotube SiNW FETs, and (iii) active silicon nanotube FETs. Following phospholipid modification of the probes to mimic the cell membrane, the kinked nanowire, branched intracellular nanotube and active silicon nanotube FET probes recorded full-amplitude intracellular action potentials from spontaneously firing cardiomyocytes. Moreover, these probes demonstrated the capability of reversible, stable, and long-term intracellular recording, thus indicating the minimal invasiveness of the new nanoscale structures and suggesting biomimetic internalization via the phospholipid modification. Simultaneous, multi-site intracellular recording from both single cells and cell networks were also readily achieved by interfacing independently addressable nanoprobe devices with cells. Finally, electronic and biological systems have been seamlessly merged in 3D for the first time using macroporous nanoelectronic scaffolds that are analogous to synthetic tissue scaffold and the extracellular matrix in tissue. Free-standing 3D nanoelectronic scaffolds were cultured with neurons, cardiomyocytes and smooth muscle cells to yield electronically-innervated synthetic or ‘cyborg’ tissues. Measurements demonstrate that innervated tissues exhibit similar cell viability as with conventional tissue scaffolds, and importantly, demonstrate that the real-time response to drugs and pH changes can be mapped in 3D through the tissues. These results open up a new field of research, wherein nanoelectronics are merged with biological systems in 3D thereby providing broad opportunities, ranging from a nanoelectronic/tissue platform for real-time pharmacological screening in 3D to implantable ‘cyborg’ tissues enabling closed-loop monitoring and treatment of diseases. Furthermore, the capability of high density scale-up of the above extra- and intracellular nanoscopic probes for action potential recording provide important tools for large-scale high spatio-temporal resolution electrical neural activity mapping in both 2D and 3D, which promises to have a profound impact on many research areas, including the mapping of activity within the brain. PMID:24073014

Use of TV in space science activities - Some considerations. [onboard primary experimental data recording

NASA Technical Reports Server (NTRS)

Bannister, T. C.

1977-01-01

Advantages in the use of TV on board satellites as the primary data-recording system in a manned space laboratory when certain types of experiments are flown are indicated. Real-time or near-real-time validation, elimination of film weight, improved depth of field and low-light sensitivity, and better adaptability to computer and electronic processing of data are spelled out as advantages of TV over photographic techniques, say, in fluid dynamics experiments, and weightlessness studies.

Feasibility of electronic peer mentoring for transition-age youth and young adults with intellectual and developmental disabilities: Project Teens making Environment and Activity Modifications.

PubMed

Kramer, Jessica M; Ryan, Cathryn T; Moore, Rachel; Schwartz, Ariel

2018-01-01

There is a need for mentoring interventions in which transition-age youth and young adults with intellectual and/or developmental disabilities (I/DD) participate as both mentors and mentees. Project TEAM (Teens making Environment and Activity Modifications) is a problem-solving intervention that includes an electronic peer-mentoring component. Forty-two mentees and nine mentors with I/DD participated. The present authors analysed recorded peer-mentoring calls and field notes for mentee engagement, mentor achievement of objectives and supports needed to implement peer mentoring. Overall, mentees attended 87% of scheduled calls and actively engaged during 94% of call objectives. Across all mentoring dyads, mentors achieved 87% of objectives and there was a significant relationship between the use of supports (mentoring script, direct supervision) and fidelity. Transition-age mentees with I/DD can engage in electronic peer mentoring to further practice problem-solving skills. Mentors with I/DD can implement electronic peer mentoring when trained personnel provide supports and individualized job accommodations. © 2017 John Wiley & Sons Ltd.

Novel psychoactive substances: An investigation of temporal trends in social media and electronic health records.

PubMed

Kolliakou, A; Ball, M; Derczynski, L; Chandran, D; Gkotsis, G; Deluca, P; Jackson, R; Shetty, H; Stewart, R

2016-10-01

Public health monitoring is commonly undertaken in social media but has never been combined with data analysis from electronic health records. This study aimed to investigate the relationship between the emergence of novel psychoactive substances (NPS) in social media and their appearance in a large mental health database. Insufficient numbers of mentions of other NPS in case records meant that the study focused on mephedrone. Data were extracted on the number of mephedrone (i) references in the clinical record at the South London and Maudsley NHS Trust, London, UK, (ii) mentions in Twitter, (iii) related searches in Google and (iv) visits in Wikipedia. The characteristics of current mephedrone users in the clinical record were also established. Increased activity related to mephedrone searches in Google and visits in Wikipedia preceded a peak in mephedrone-related references in the clinical record followed by a spike in the other 3 data sources in early 2010, when mephedrone was assigned a 'class B' status. Features of current mephedrone users widely matched those from community studies. Combined analysis of information from social media and data from mental health records may assist public health and clinical surveillance for certain substance-related events of interest. There exists potential for early warning systems for health-care practitioners. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

New Evaluation of the Electronically Activated Recorder (EAR): Obtrusiveness, Compliance, and Participant Self-selection Effects.

PubMed

Manson, Joseph H; Robbins, Megan L

2017-01-01

The Electronically Activated Recorder (EAR) is a method for collecting periodic brief audio snippets of participants' daily lives using a portable recording device. The EAR can potentially intrude into people's privacy, alter their natural behavior, and introduce self-selection biases greater than in other types of social science methods. Previous research (Mehl and Holleran, 2007, hereafter M&H) has shown that participant non-compliance with, and perceived obtrusiveness of, an EAR protocol are both low. However, these questions have not been addressed in jurisdictions that require the consent of all parties to recording conversations. This EAR study required participants to wear a button bearing a microphone icon and the words "This conversation may be recorded" to comply with California's all-party consent law. Results revealed self-reported obtrusiveness and non-compliance were actually lower in the present study than in the M&H study. Behaviorally assessed non-compliance did not differ between the two studies. Participants in the present study talked more about being in the study than participants in the M&H study, but such talk still comprised <2% of sampled conversations. Another potential problem with the EAR, participant self-selection bias, was addressed by comparing the EAR volunteers' HEXACO personality dimensions to a non-volunteer sample drawn from the same student population. EAR volunteers were significantly and moderately higher in Conscientiousness, and lower in Emotionality, than non-volunteers. In conclusion, the EAR method can be successfully implemented in at least one all-party consent state (California). Interested researchers are encouraged to review this procedure with their own legal counsel.

Words matter: Implementing the electronically activated recorder in schizotypy.

PubMed

Minor, Kyle S; Davis, Beshaun J; Marggraf, Matthew P; Luther, Lauren; Robbins, Megan L

2018-03-01

In schizophrenia-spectrum populations, analyzing the words people use has offered promise for unlocking information about affective states and social behaviors. The electronically activated recorder (EAR) is an application-based program that is combined with widely used smartphone technology to capture a person's real-world interactions via audio recordings. It improves on the ecological validity of current methodologies by providing objective and naturalistic samples of behavior. This study is the first to implement the EAR in people endorsing elevated traits of schizophrenia-spectrum personality disorders (i.e., schizotypy), and we expected the EAR to (a) differentiate high and low schizotypy groups on affective disturbances and social engagement and (b) show that high schizotypy status moderates links between affect and social behavior using a multimethod approach. Lexical analysis of EAR recordings revealed greater negative affect and decreased social engagement in those high in schizotypy. When assessing specific traits, EAR and ecological momentary assessment (EMA) converged to show that positive schizotypy predicted negative affect. Finally, high schizotypy status moderated links between negative affect and social engagement when the EAR was combined with EMA. Adherence did not influence results, as both groups wore the EAR more than 90% of their waking hours. Findings supported using the EAR to assess real-world expressions of personality and functioning in schizotypy. Evidence also showed that the EAR can be used alongside EMA to provide a mixed-method, real-world assessment that is high in ecological validity and offers a window into the daily lives of those with elevated traits of schizophrenia-spectrum personality disorders. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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.

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.

78 FR 32001 - Agency Information Collection Activities; Approval of a New Information Collection Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

... consultants and academic researchers with expertise in the motor carrier industry and survey design...: Driver and Carrier Surveys Related to Electronic Onboard Recorders (EOBRs), and Potential Harassment... the collection of survey data, the issue of driver harassment and determine the extent to which...

76 FR 35900 - Agency Information Collection Activities: Proposed Collection: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... few new questions will be asked about health center Electronic Health Record reporting capabilities... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency... States Code, as amended by the Paperwork Reduction Act of 1995, Pub. L. 104-13), the Health Resources and...

Ellen Ochoa and Valeri Tokarev prepare for Node 1/Unity ingress

NASA Image and Video Library

2017-04-20

S96-E-5002 (29 MAY 1999) --- With the aid of a lamp, cosmonaut Valery Tokarev and astronaut Ellen Ochoa participate in the activation of SPACEHAB on Flight Day 2. The photo was recorded with an electronic still camera (ESC) at 07:18:06 GMT, May 29, 1999.

Robinson on aft flight deck

NASA Image and Video Library

1998-10-30

STS095-E-5065 (30 Oct. 1998) --- Astronaut Stephen K. Robinson, STS-95 mission specialist, looks toward Earth in this electronic still camera's (ESC) image of Flight Day two activity aboard the Space Shuttle Discovery. The scene was recorded on the aft flight deck at 12:02:11 GMT, Oct. 30.

Safety and fitness electronic records system (SAFER) : draft master test plan

DOT National Transportation Integrated Search

1995-12-31

The purpose of this plan is to establish a formal set of guidelines and activities to be : adhered to and performed by JHU/APL and the developer to ensure that the SAFER System has been tested successfully and is fully compliant with the SAFER System...

The Lay Assessment of Subclinical Depression in Daily Life

ERIC Educational Resources Information Center

Mehl, Matthias R.

2006-01-01

This study examined how laypersons assess subclinical depression in others on the basis of information about their daily lives. For 2 days, 96 participants were tracked with the Electronically Activated Recorder, a naturalistic observation method that samples ambient sounds from participants' momentary environments. Judges rated participants'…

12 CFR 7.5007 - Correspondent services.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Item processing services and related software; (f) Document control and record keeping through the use... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Correspondent services. 7.5007 Section 7.5007... Electronic Activities § 7.5007 Correspondent services. It is part of the business of banking for a national...

75 FR 29568 - Extension of Agency Information Collection Activity Under OMB Review: Aircraft Operator Security

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

... Act (PRA) Officer, Office of Information Technology (OIT), TSA-11, Transportation Security..., electronic, mechanical, or other technological collection techniques or other forms of information technology... criminal history records check (CHRC). As part of the CHRC process, the individual must provide identifying...

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.

Impact of electronic health record clinical decision support on the management of pediatric obesity.

PubMed

Shaikh, Ulfat; Berrong, Jeanette; Nettiksimmons, Jasmine; Byrd, Robert S

2015-01-01

Clinicians vary significantly in their adherence to clinical guidelines for overweight/obesity. This study assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity. Although clinical guideline adherence increased significantly, it was far from universal. It is unknown if modest improvements in adherence to clinical guidelines translate to improvements in children's health. However, this intervention was relatively easy to implement and produced measurable improvements in health care delivery. © 2014 by the American College of Medical Quality.

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.

Governance and oversight of researcher access to electronic health data: the role of the Independent Scientific Advisory Committee for MHRA database research, 2006-2015.

PubMed

Waller, P; Cassell, J A; Saunders, M H; Stevens, R

2017-03-01

In order to promote understanding of UK governance and assurance relating to electronic health records research, we present and discuss the role of the Independent Scientific Advisory Committee (ISAC) for MHRA database research in evaluating protocols proposing the use of the Clinical Practice Research Datalink. We describe the development of the Committee's activities between 2006 and 2015, alongside growth in data linkage and wider national electronic health records programmes, including the application and assessment processes, and our approach to undertaking this work. Our model can provide independence, challenge and support to data providers such as the Clinical Practice Research Datalink database which has been used for well over 1,000 medical research projects. ISAC's role in scientific oversight ensures feasible and scientifically acceptable plans are in place, while having both lay and professional membership addresses governance issues in order to protect the integrity of the database and ensure that public confidence is maintained.

Results of the Arizona Medicaid health information technology pharmacy focus groups.

PubMed

Warholak, Terri L; Murcko, Anita; McKee, Megan; Urbine, Terry

2011-12-01

In 2007, a federal Medicaid Transformation Grant was awarded to design, develop, and deploy a statewide Health Information Exchange and Electronic Health Record in Arizona, United States. To explore the health information technology needs, knowledge, and expectations of Arizona's health care professionals, moderated focus groups were conducted. This article describes the results of the pharmacist focus groups. Focus group activities included a brief presentation, completion of a paper-based survey, and group discussion. The methods included solicitation by invitation, participant selection, meeting content, collaterals, focus group execution, recording, analysis, and discerning comparability among groups. Pharmacy focus group discussions centered on electronic prescribing, including the anticipated advantages: reducing handwriting interpretation errors, improving formulary compliance, improving communication with prescribers, increasing efficiency, and ensuring data accuracy. Disadvantages included: medication errors, inadequate training and knowledge of software applications, and inflated patient expectations. Pharmacists ranked e-prescribing as the highest priority feature of an electronic health system. Copyright © 2011 Elsevier Inc. All rights reserved.

The Effect of Electronic Health Record Use and Patient-Centered Communication on Cancer Screening Behavior: An Analysis of the Health Information National Trends Survey.

PubMed

Totzkay, Daniel; Silk, Kami J; Sheff, Sarah E

2017-07-01

The present study used the 2013 Health Information National Trends Survey (N = 3185) to examine the effects of patient-centered communication (PCC) and the use of electronic health records (EHRs) on the likelihood of patients receiving a recommended screening for cancer (i.e., mammogram, PSA test). Self-determination theory, a framework of self-initiated extrinsic behaviors, was applied to test mediation models of PCC and EHR use, respectively, through patient activation. The results demonstrated that PCC and EHR use predicted cancer screening (mediated through patient activation), but only for women recommended for biannual mammograms. The aforementioned relationship was not found for men who are recommended for prostate cancer screening. PCC and EHRs do appear to facilitate a patient's ability to take care of their own health, but only under certain circumstances. It was additionally found that men were more likely to report higher degrees of physician PCC when their physicians maintained an EHR, whereas women reported no difference. Future research should examine more nuanced personality factors that affect the perception of PCC in the presence of EHRs and the relationship between men's activation and likelihood of receiving a cancer screen.

Choices in Cataloging Electronic Journals

ERIC Educational Resources Information Center

Leathem, Cecilia A.

2005-01-01

Libraries and catalogers face choices in the treatment of the growing collections of electronic journals. Policies issued by CONSER and the Library of Congress allow libraries to edit existing print records to accommodate information pertaining to the electronic versions (single record option) or to create new records for them. The discussion…

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2013 CFR

2013-10-01

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

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2014 CFR

2014-10-01

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

42 CFR 425.506 - Electronic health records technology.

Code of Federal Regulations, 2012 CFR

2012-10-01

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

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...

Teaching Electronic Records Management in the Archival Curriculum

ERIC Educational Resources Information Center

Zhang, Jane

2016-01-01

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

Privacy, confidentiality, and electronic medical records.

PubMed Central

Barrows, R C; Clayton, P D

1996-01-01

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

Are electronic health records ready for genomic medicine?

PubMed

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

2009-07-01

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

How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care.

PubMed

Asan, Onur; Young, Henry N; Chewning, Betty; Montague, Enid

2015-03-01

Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Accelerated Adoption of Advanced Health Information Technology in Beacon Community Health Centers.

PubMed

Jones, Emily; Wittie, Michael

2015-01-01

To complement national and state-level HITECH Act programs, 17 Beacon communities were funded to fuel community-wide use of health information technology to improve quality. Health centers in Beacon communities received supplemental funding. This article explores the association between participation in the Beacon program and the adoption of electronic health records. Using the 2010-2012 Uniform Data System, trends in health information technology adoption among health centers located within and outside of Beacon communities were explored using differences in mean t tests and multivariate logistic regression. Electronic health record adoption was widespread and rapidly growing in all health centers, especially quality improvement functionalities: structured data capture, order and results management, and clinical decision support. Adoption lagged for functionalities supporting patient engagement, performance measurement, care coordination, and public health. The use of advanced functionalities such as care coordination grew faster in Beacon health centers, and Beacon health centers had 1.7 times higher odds of adopting health records with basic safety and quality functionalities in 2010-2012. Three factors likely underlie these findings: technical assistance, community-wide activation supporting health information exchange, and the layering of financial incentives. Additional technical assistance and community-wide activation is needed to support the use of functionalities that are currently lagging. © Copyright 2015 by the American Board of Family Medicine.

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

Theoretical analysis of intracortical microelectrode recordings

NASA Astrophysics Data System (ADS)

Lempka, Scott F.; Johnson, Matthew D.; Moffitt, Michael A.; Otto, Kevin J.; Kipke, Daryl R.; McIntyre, Cameron C.

2011-08-01

Advanced fabrication techniques have now made it possible to produce microelectrode arrays for recording the electrical activity of a large number of neurons in the intact brain for both clinical and basic science applications. However, the long-term recording performance desired for these applications is hindered by a number of factors that lead to device failure or a poor signal-to-noise ratio (SNR). The goal of this study was to identify factors that can affect recording quality using theoretical analysis of intracortical microelectrode recordings of single-unit activity. Extracellular microelectrode recordings were simulated with a detailed multi-compartment cable model of a pyramidal neuron coupled to a finite-element volume conductor head model containing an implanted recording microelectrode. Recording noise sources were also incorporated into the overall modeling infrastructure. The analyses of this study would be very difficult to perform experimentally; however, our model-based approach enabled a systematic investigation of the effects of a large number of variables on recording quality. Our results demonstrate that recording amplitude and noise are relatively independent of microelectrode size, but instead are primarily affected by the selected recording bandwidth, impedance of the electrode-tissue interface and the density and firing rates of neurons surrounding the recording electrode. This study provides the theoretical groundwork that allows for the design of the microelectrode and recording electronics such that the SNR is maximized. Such advances could help enable the long-term functionality required for chronic neural recording applications.

Theoretical analysis of intracortical microelectrode recordings

PubMed Central

Lempka, Scott F; Johnson, Matthew D; Moffitt, Michael A; Otto, Kevin J; Kipke, Daryl R; McIntyre, Cameron C

2011-01-01

Advanced fabrication techniques have now made it possible to produce microelectrode arrays for recording the electrical activity of a large number of neurons in the intact brain for both clinical and basic science applications. However, the long-term recording performance desired for these applications is hindered by a number of factors that lead to device failure or a poor signal-to-noise ratio (SNR). The goal of this study was to identify factors that can affect recording quality using theoretical analysis of intracortical microelectrode recordings of single-unit activity. Extracellular microelectrode recordings were simulated with a detailed multi-compartment cable model of a pyramidal neuron coupled to a finite element volume conductor head model containing an implanted recording microelectrode. Recording noise sources were also incorporated into the overall modeling infrastructure. The analyses of this study would be very difficult to perform experimentally; however, our model-based approach enabled a systematic investigation of the effects of a large number of variables on recording quality. Our results demonstrate that recording amplitude and noise are relatively independent of microelectrode size, but instead are primarily affected by the selected recording bandwidth, impedance of the electrode-tissue interface, and the density and firing rates of neurons surrounding the recording electrode. This study provides the theoretical groundwork that allows for the design of the microelectrode and recording electronics such that the SNR is maximized. Such advances could help enable the long-term functionality required for chronic neural recording applications. PMID:21775783

Surgical electronic logbook: A step forward.

PubMed

Gómez Díaz, Carlos Javier; Luna Aufroy, Alexis; Rebasa Cladera, Pere; Serra Pla, Sheila; Jurado Ruiz, Cristina; Mora López, Laura; Serra Aracil, Xavier; Navarro Soto, Salvador

2015-12-01

The surgical electronic logbook (surgical e-logbook) aims to: simplify registration of the training activities of surgical residents, and to obtain reliable and detailed reports about these activities for resident evaluation. The surgical e-logbook is a unique and shared database. Residents prospectively record their activities in 3 areas: surgical, scientific and teaching. We can access activity reports that are constantly updated. Study period using the surgical e-logbook: Between June 2011 and May 2013. Number of surgeries reported: 4,255. Number of surgical procedures reported: 11,907. Number of surgeries per resident per year reported: 250. Number of surgical procedures per resident per year reported: 700. Surgical activity as a primary surgeon during the first year of residency is primarily in emergency surgery (68,01%) and by laparotomy (97,73%), while during the fifth year of residency 51,27% is performed in elective surgery and laparoscopy is used in 23,10% of cases. During this period, residents participated in a total of 11 scientific publications, 75 conference presentations and 69 continuing education activities. The surgical e-logbook is a useful tool that simplifies the recording and analysis of data about surgical and scientific activities of the residents. It is a step forward in the evaluation of the training of surgical residents, however, is only an intermediate step towards the development of a larger Spanish registry. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

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.

21 CFR 1305.27 - Preservation of electronic orders.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

21 CFR 1305.27 - Preservation of electronic orders.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

21 CFR 1305.27 - Preservation of electronic orders.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

21 CFR 1305.27 - Preservation of electronic orders.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

21 CFR 1305.27 - Preservation of electronic orders.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

The strategic use of lecture recordings to facilitate an active and self-directed learning approach.

PubMed

Topale, Luminica

2016-08-12

New learning technologies have the capacity to dramatically impact how students go about learning and to facilitate an active, self-directed learning approach. In U. S. medical education, students encounter a large volume of content, which must be mastered at an accelerated pace. The added pressure to excel on the USMLE Step 1 licensing exam and competition for residency placements, require that students adopt an informed approach to the use of learning technologies so as to enhance rather than to detract from the learning process. The primary aim of this study was to gain a better understanding of how students were using recorded lectures in their learning and how their study habits have been influenced by the technology. Survey research was undertaken using a convenience sample. Students were asked to voluntarily participate in an electronic survey comprised of 27 closed ended, multiple choice questions, and one open ended item. The survey was designed to explore students' perceptions of how recorded lectures affected their choices regarding class participation and impacted their learning and to gain an understanding of how recorded lectures facilitated a strategic, active learning process. Findings revealed that recorded lectures had little influence on students' choices to participate, and that the perceived benefits of integrating recorded lectures into study practices were related to their facilitation of and impact on efficient, active, and self-directed learning. This study was a useful investigation into how the availability of lecture capture technology influenced medical students' study behaviors and how students were making valuable use of the technology as an active learning tool.

Privacy, consent, and the electronic mental health record: The Person vs. the System.

PubMed

Clemens, Norman A

2012-01-01

As electronic health record systems become widely adopted and proposals are advanced to integrate mental health with general health systems, there is mounting pressure to include mental health information on the same basis as general health information without any requirement for active, individual patient consent to do so. A prime example is the current effort to change the Mental Health Information Act of the District of Columbia, which has, up till now, stood as a model for protection of the privacy of patients with mental illness, the requirement of informed consent for disclosure of health information, and delimitation of minimum necessary disclosure. Mental health information is exceptionally sensitive and potentially damaging if privacy is breached, which makes patients reluctant to seek treatment if they cannot be assured of confidentiality. In addition, there have been spectacular breaches of the security of large electronic health record databases. A subtle but more likely threat is the possibility that mental health information in networks could be fully accessible to all of the patient's providers in a network, not just those for whom it would be necessary to the patient's care. In the 1996 Supreme Court decision in Jaffee v. Redmond, the high court recognized that confidentiality is essential for patients to engage in effective psychotherapy, and HIPAA maintains that special status in the protection of psychotherapy notes as well as explicitly stating that it defers to state laws that are more protective of confidentiality than is HIPAA itself. Highly sensitive information also exists in mental health records aside from psychotherapy notes. Any change in the laws that govern informed consent for disclosure of mental health information must take these factors into account. Specifically, the author opposes any change that would assume tacit consent to release mental health information through an electronic health information exchange in the absence of a patient-initiated request to "opt out"; the requirement that the patient give active, informed and non-coerced consent to disclose information--"opt in"--must be preserved.

7 CFR 1409.8 - Public inspection and copying of records; applicable fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., electronic recording, transcription of the recording, or minutes of the discussion of any item on the agenda...., Washington, DC 20250. (c) The transcripts, minutes, or transcriptions of electronic recordings of a Board... of transcription or duplication. ...

7 CFR 1409.8 - Public inspection and copying of records; applicable fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., electronic recording, transcription of the recording, or minutes of the discussion of any item on the agenda...., Washington, DC 20250. (c) The transcripts, minutes, or transcriptions of electronic recordings of a Board... of transcription or duplication. ...

22 CFR 503.9 - Electronic records.

Code of Federal Regulations, 2012 CFR

2012-04-01

... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

22 CFR 503.9 - Electronic records.

Code of Federal Regulations, 2013 CFR

2013-04-01

... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

22 CFR 503.9 - Electronic records.

Code of Federal Regulations, 2014 CFR

2014-04-01

... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

76 FR 13121 - Electronic On-Board Recorders and Hours of Service Supporting Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-10

... DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration 49 CFR Parts 385, 390, and 395 [Docket No. FMCSA-2010-0167] RIN 2126-AB20 Electronic On-Board Recorders and Hours of Service... comment period for the Electronic On-Board Recorder and Hours of Service Supporting Documents Notice of...

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…

Electronic Imaging in Admissions, Records & Financial Aid Offices.

ERIC Educational Resources Information Center

Perkins, Helen L.

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

Technology Acceptance of Electronic Medical Records by Nurses

ERIC Educational Resources Information Center

Stocker, Gary

2010-01-01

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

Development and validation of an automated ventilator-associated event electronic surveillance system: A report of a successful implementation.

PubMed

Hebert, Courtney; Flaherty, Jennifer; Smyer, Justin; Ding, Jing; Mangino, Julie E

2018-03-01

Surveillance is an important tool for infection control; however, this task can often be time-consuming and take away from infection prevention activities. With the increasing availability of comprehensive electronic health records, there is an opportunity to automate these surveillance activities. The objective of this article is to describe the implementation of an electronic algorithm for ventilator-associated events (VAEs) at a large academic medical center METHODS: This article reports on a 6-month manual validation of a dashboard for VAEs. We developed a computerized algorithm for automatically detecting VAEs and compared the output of this algorithm to the traditional, manual method of VAE surveillance. Manual surveillance by the infection preventionists identified 13 possible and 11 probable ventilator-associated pneumonias (VAPs), and the VAE dashboard identified 16 possible and 13 probable VAPs. The dashboard had 100% sensitivity and 100% accuracy when compared with manual surveillance for possible and probable VAP. We report on the successfully implemented VAE dashboard. Workflow of the infection preventionists was simplified after implementation of the dashboard with subjective time-savings reported. Implementing a computerized dashboard for VAE surveillance at a medical center with a comprehensive electronic health record is feasible; however, this required significant initial and ongoing work on the part of data analysts and infection preventionists. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Measure Once, Cut Twice – Adding Patient-Reported Outcome Measures to the Electronic Health Record for Comparative Effectiveness Research

PubMed Central

Wu, Albert W.; Kharrazi, Hadi; Boulware, L. Ebony; Snyder, Claire F.

2013-01-01

Objective This paper presents the current state of patient-reported outcome measures, and explains new opportunities for leveraging the recent adoption of electronic health records to expand the application of patient-reported outcomes in both clinical care and comparative effectiveness research. Study Design and Setting Historic developments of patient-reported outcome, electronic health record, and comparative effectiveness research are analyzed in two dimensions: patient-centeredness and digitization. We pose the question: “What needs to be standardized around the collection of patient-reported outcomes in electronic health records for comparative effectiveness research?” Results We identified three converging trends: the progression of patient-reported outcomes toward greater patient centeredness and electronic adaptation; the evolution of electronic health records into personalized and fully digitized solutions; the shift toward patient-oriented comparative effectiveness research. Related to this convergence, we propose an architecture for patient-reported outcome standardization that could serve as a first step toward a more comprehensive integration of patient-reported outcomes with electronic health record for both practice and research. Conclusion The science of patient-reported outcome measurement has matured sufficiently to be integrated routinely into electronic health records and other e-health solutions to collect data on an ongoing basis for clinical care and comparative effectiveness research. Further efforts and ideally coordinated efforts from various stakeholders are needed to refine the details of the proposed framework for standardization. PMID:23849145

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.

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, ...

21 CFR 111.605 - What requirements apply to the records that you make and keep?

Code of Federal Regulations, 2010 CFR

2010-04-01

..., microfiche, or other accurate reproductions of the original records), or as electronic records. (c) All electronic records must comply with part 11 of this chapter. ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false What requirements apply to the records that you...

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.

Splash: a software tool for stereotactic planning of recording chamber placement and electrode trajectories.

PubMed

Sperka, Daniel J; Ditterich, Jochen

2011-01-01

While computer-aided planning of human neurosurgeries is becoming more and more common, animal researchers still largely rely on paper atlases for planning their approach before implanting recording chambers to perform invasive recordings of neural activity, which makes this planning process tedious and error-prone. Here we present SPLASh (Stereotactic PLAnning Software), an interactive software tool for the stereotactic planning of recording chamber placement and electrode trajectories. SPLASh has been developed for monkey cortical recordings and relies on a combination of structural MRIs and electronic brain atlases. Since SPLASh is based on the neuroanatomy software Caret, it should also be possible to use it for other parts of the brain or other species for which Caret atlases are available. The tool allows the user to interactively evaluate different possible placements of recording chambers and to simulate electrode trajectories.

Splash: A Software Tool for Stereotactic Planning of Recording Chamber Placement and Electrode Trajectories

PubMed Central

Sperka, Daniel J.; Ditterich, Jochen

2011-01-01

While computer-aided planning of human neurosurgeries is becoming more and more common, animal researchers still largely rely on paper atlases for planning their approach before implanting recording chambers to perform invasive recordings of neural activity, which makes this planning process tedious and error-prone. Here we present SPLASh (Stereotactic PLAnning Software), an interactive software tool for the stereotactic planning of recording chamber placement and electrode trajectories. SPLASh has been developed for monkey cortical recordings and relies on a combination of structural MRIs and electronic brain atlases. Since SPLASh is based on the neuroanatomy software Caret, it should also be possible to use it for other parts of the brain or other species for which Caret atlases are available. The tool allows the user to interactively evaluate different possible placements of recording chambers and to simulate electrode trajectories. PMID:21472085

Ethics of medical records and professional communications.

PubMed

Recupero, Patricia R

2008-01-01

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

A gravimetric method for the measurement of total spontaneous activity in rats.

PubMed

Biesiadecki, B J; Brand, P H; Koch, L G; Britton, S L

1999-10-01

Currently available methods for the measurement of spontaneous activity of laboratory animals require expensive, specialized equipment and may not be suitable for use in low light conditions with nocturnal species. We developed a gravimetric method that uses common laboratory equipment to quantify the total spontaneous activity of rats and is suitable for use in the dark. The rat in its home cage is placed on a top-loading electronic balance interfaced to a computer. Movements are recorded by the balance as changes in weight and transmitted to the computer at 10 Hz. Data are analyzed on-line to derive the absolute value of the difference in weight between consecutive samples, and the one-second average of the absolute values is calculated. The averages are written to file for off-line analysis and summed over the desired observation period to provide a measure of total spontaneous activity. The results of in vitro experiments demonstrated that: 1) recorded weight changes were not influenced by position of the weight on the bottom of the cage, 2) values recorded from a series of weight changes were not significantly different from the calculated values, 3) the constantly decreasing force exerted by a swinging pendulum placed on the balance was accurately recorded, 4) the measurement of activity was not influenced by the evaporation of a fluid such as urine, and 5) the method can detect differences in the activity of sleeping and waking rats over a 10-min period, as well as during 4-hr intervals recorded during active (night-time) and inactive (daytime) periods. These results demonstrate that this method provides an inexpensive, accurate, and noninvasive method to quantitate the spontaneous activity of small animals.

Nurse's use of power to standardise nursing terminology in electronic health records.

PubMed

Ali, Samira; Sieloff, Christina L

2017-07-01

To describe nurses' use of power to influence the incorporation of standardised nursing terminology within electronic health records. Little is known about nurses' potential use of power to influence the incorporation of standardised nursing terminology within electronic health records. The theory of group power within organisations informed the design of the descriptive, cross-sectional study used a survey method to assess nurses' use of power to influence the incorporation of standardised nursing terminology within electronic health records. The Sieloff-King Assessment of Group Power within Organizations © and Nursing Power Scale was used. A total of 232 nurses responded to the survey. The mean power capability score was moderately high at 134.22 (SD 18.49), suggesting that nurses could use power to achieve the incorporation of standardised nursing terminology within electronic health records. The nurses' power capacity was significantly correlated with their power capability (r = 0.96, P < 0.001). Nurses may use power to achieve their goals, such as the incorporation of standardised nursing terminology within electronic health records. Nurse administrators may use their power to influence the incorporation of standardised nursing terminology within electronic health records. If nurses lack power, this could decrease nurses' ability to achieve their goals and contribute to the achievement of effective patient outcomes. © 2017 John Wiley & Sons Ltd.

Uses of electromyography in dentistry: An overview with meta-analysis.

PubMed

Nishi, Shamima Easmin; Basri, Rehana; Alam, Mohammad Khursheed

2016-01-01

The purpose of this study was to review the uses of electromyography (EMG) in dentistry in the last few years in related research. EMG is an advanced technique to record and evaluate muscle activity. In the previous days, EMG was only used for medical sciences, but now EMG playing a tremendous role in medical as well as dental sector. Several electronic databases such as Google Scholar, PubMed, Science Direct, and Web of Science were systematically searched for studies published until July 2015. EMG can be used in both diagnosis and treatment purpose to record neuromuscular activity. In dentistry, we can utilize EMG to evaluate muscular activity in function such as chewing and biting or parafunctional activities such as clenching and bruxism. In case of TMJ and myofascial pain disorders, EMG widely is used in the last few years. EMG is one of biometric tests that occur in the modern evidence-based dentistry practice.

Panic disorder and locomotor activity

PubMed Central

Sakamoto, Noriyuki; Yoshiuchi, Kazuhiro; Kikuchi, Hiroe; Takimoto, Yoshiyuki; Kaiya, Hisanobu; Kumano, Hiroaki; Yamamoto, Yoshiharu; Akabayashi, Akira

2008-01-01

Background Panic disorder is one of the anxiety disorders, and anxiety is associated with some locomotor activity changes such as "restlessness". However, there have been few studies on locomotor activity in panic disorder using actigraphy, although many studies on other psychiatric disorders have been reported using actigraphy. Therefore, the aim of the present study was to investigate the relationship between panic disorder and locomotor activity pattern using a wrist-worn activity monitor. In addition, an ecological momentary assessment technique was used to record panic attacks in natural settings. Methods Sixteen patients with panic disorder were asked to wear a watch-type computer as an electronic diary for recording panic attacks for two weeks. In addition, locomotor activity was measured and recorded continuously in an accelerometer equipped in the watch-type computer. Locomotor activity data were analyzed using double cosinor analysis to calculate mesor and the amplitude and acrophase of each of the circadian rhythm and 12-hour harmonic component. Correlations between panic disorder symptoms and locomotor activity were investigated. Results There were significant positive correlations between the frequency of panic attacks and mesor calculated from double cosinor analysis of locomotor activity (r = 0.55) and between HAM-A scores and mesor calculated from double cosinor analysis of locomotor activity (r = 0.62). Conclusion Panic disorder patients with more panic attacks and more anxiety have greater objectively assessed locomotor activity, which may reflect the "restlessness" of anxiety disorders. PMID:19017383

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.

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.

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...

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...

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...

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…

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…

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…

77 FR 7562 - Electronic On-Board Recorders and Hours of Service Supporting Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

..., and 395 [Docket No. FMCSA-2010-0167] RIN 2126-AB20 Electronic On-Board Recorders and Hours of Service... intent. SUMMARY: FMCSA announces its intent to move forward with the Electronic On-Board Recorders and... Appeals for the Seventh Circuit. OOIDA raised several concerns relating to EOBRs and their potential use...

77 FR 58834 - Agency Information Collection Activities; Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-24

...-16 years, who watch movies, listen to music, and/or play game applications (``apps'') on smartphones... Motion Picture, Music Recording & Electronic Game Industries.\\1\\ The 2000 Report examined the structure... 2007.\\6\\ Those reports found less marketing of violent R-rated films \\7\\ and M-rated video games \\8\\ to...

78 FR 32242 - Agency Information Collection Activities; Submission to the Office of Management and Budget for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-29

...; Submission to the Office of Management and Budget for Review and Approval; Comment Request; Fiscal Operations... considered public records. Title of Collection: Fiscal Operations Report for 2012-2013 and Application to...: 37,176. Abstract: The data submitted electronically in the Fiscal Operations Report and Application...

76 FR 22895 - Agency Information Collection Activities: Proposed Collection; Submission for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... records, and to produce reports as the Commission prescribes by regulation or order. Accordingly, the EEOC... Opportunity Commission (EEOC or Commission) hereby gives notice that it has submitted to the Office of... sending written comments to EEOC, you may submit comments and attachments electronically at http://www...

75 FR 18824 - Agency Information Collection Activities: Notice of Intent To Renew Collection 3038-0019, Stocks...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

... Renew Collection 3038-0019, Stocks of Grain in Licensed Warehouses AGENCY: Commodity Futures Trading...., permitting electronic submission of responses. Stocks of Grain in Licensed Warehouses, OMB Control No. 3038... warehouses regular for delivery to keep records on stocks of commodities and make reports on call by the...

Flexible Organic Electronics for Use in Neural Sensing

PubMed Central

Bink, Hank; Lai, Yuming; Saudari, Sangameshwar R.; Helfer, Brian; Viventi, Jonathan; Van der Spiegel, Jan; Litt, Brian; Kagan, Cherie

2016-01-01

Recent research in brain-machine interfaces and devices to treat neurological disease indicate that important network activity exists at temporal and spatial scales beyond the resolution of existing implantable devices. High density, active electrode arrays hold great promise in enabling high-resolution interface with the brain to access and influence this network activity. Integrating flexible electronic devices directly at the neural interface can enable thousands of multiplexed electrodes to be connected using many fewer wires. Active electrode arrays have been demonstrated using flexible, inorganic silicon transistors. However, these approaches may be limited in their ability to be cost-effectively scaled to large array sizes (8×8 cm). Here we show amplifiers built using flexible organic transistors with sufficient performance for neural signal recording. We also demonstrate a pathway for a fully integrated, amplified and multiplexed electrode array built from these devices. PMID:22255558

19 CFR 163.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

...; electronically stored or transmitted information or data; books; papers; correspondence; accounts; financial... electronic records or paper documents; (2) Electronic information which is in a readable format such as a facsimile paper format or an electronic or hardcopy spreadsheet; (3) In the case of a paper record that is...

A new extracellular multirecording system for electrophysiological studies: application to hippocampal organotypic cultures.

PubMed

Stoppini, L; Duport, S; Corrèges, P

1997-03-01

The present paper describes a new multirecording device which performs continuous electrophysiological studies on organotypic cultures. This device is formed by a card (Physiocard) carrying the culture which is inserted into an electronic module. Electrical activities are recorded by an array of 30 biocompatible microelectrodes which are adjusted into close contact with the upper surface of the slice culture. The microelectrode array is integrated into the card enabling electrical stimulation and recording of neurons over periods ranging from several hours to a few days outside a Faraday cage. Neuronal responses are recorded and analyzed by a dedicated electronic and acquisition chain. A perfusion chamber is contained in the card, allowing continuous perfusion in sterile conditions. Electrophysiological extracellular recordings and some drugs' effects obtained with this system in hippocampal slice cultures were identical to conventional electrophysiological set-up results with tetrodotoxin, bicuculline, kainate, dexamethasone and NBQX. The Physiocard system allows new insights for studies on nervous tissue and allows sophisticated approaches to be used quicker and more easily. It could be used for various neurophysiological studies or screening tests such as neural network mapping, nervous recovery, epilepsy, neurotoxicity or neuropharmacology.

Patient engagement in the inpatient setting: a systematic review.

PubMed

Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

2014-01-01

To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement ('self-efficacy', 'patient empowerment', 'patient activation', or 'patient engagement'), (2) involved health information technology ('technology', 'games', 'electronic health record', 'electronic medical record', or 'personal health record'), and (3) took place in the inpatient setting ('inpatient' or 'hospital'). Only English language studies were reviewed. 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. 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.

Health information technology to guide pediatric obesity management.

PubMed

McDonald, Julia; Goldman, Roberta E; O'Brien, Ashley; Ayash, Christine; Mitchell, Kathy; Marshall, Richard; Simon, Steven R; Taveras, Elsie M

2011-06-01

The purpose of this study was to examine pediatricians' familiarity with expert committee recommendations on the management of childhood obesity and their use of health information technology for obesity-related care. The authors interviewed 35 pediatricians from 17 primary care practices using an electronic health record; immersion crystallization facilitated analysis of the qualitative data. Nearly all pediatricians were unfamiliar with expert recommendations; however, all participants reported using growth charts and providing nutrition and physical activity counseling. Most participants wanted easy access to educational materials they could print for patients. The majority of participants were in favor of an electronic alert to identify obese patients, remind clinicians of current guidelines, and facilitate ordering, believing it would help standardize care. Concerns included "alert fatigue," distraction, and disruption of workflow. Suggestions for future electronic functions included tailored educational materials and physical activity resources customized by patient address.

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

Predictive modeling of structured electronic health records for adverse drug event detection.

PubMed

Zhao, Jing; Henriksson, Aron; Asker, Lars; Boström, Henrik

2015-01-01

The digitization of healthcare data, resulting from the increasingly widespread adoption of electronic health records, has greatly facilitated its analysis by computational methods and thereby enabled large-scale secondary use thereof. This can be exploited to support public health activities such as pharmacovigilance, wherein the safety of drugs is monitored to inform regulatory decisions about sustained use. To that end, electronic health records have emerged as a potentially valuable data source, providing access to longitudinal observations of patient treatment and drug use. A nascent line of research concerns predictive modeling of healthcare data for the automatic detection of adverse drug events, which presents its own set of challenges: it is not yet clear how to represent the heterogeneous data types in a manner conducive to learning high-performing machine learning models. Datasets from an electronic health record database are used for learning predictive models with the purpose of detecting adverse drug events. The use and representation of two data types, as well as their combination, are studied: clinical codes, describing prescribed drugs and assigned diagnoses, and measurements. Feature selection is conducted on the various types of data to reduce dimensionality and sparsity, while allowing for an in-depth feature analysis of the usefulness of each data type and representation. Within each data type, combining multiple representations yields better predictive performance compared to using any single representation. The use of clinical codes for adverse drug event detection significantly outperforms the use of measurements; however, there is no significant difference over datasets between using only clinical codes and their combination with measurements. For certain adverse drug events, the combination does, however, outperform using only clinical codes. Feature selection leads to increased predictive performance for both data types, in isolation and combined. We have demonstrated how machine learning can be applied to electronic health records for the purpose of detecting adverse drug events and proposed solutions to some of the challenges this presents, including how to represent the various data types. Overall, clinical codes are more useful than measurements and, in specific cases, it is beneficial to combine the two.

Predictive modeling of structured electronic health records for adverse drug event detection

PubMed Central

2015-01-01

Background The digitization of healthcare data, resulting from the increasingly widespread adoption of electronic health records, has greatly facilitated its analysis by computational methods and thereby enabled large-scale secondary use thereof. This can be exploited to support public health activities such as pharmacovigilance, wherein the safety of drugs is monitored to inform regulatory decisions about sustained use. To that end, electronic health records have emerged as a potentially valuable data source, providing access to longitudinal observations of patient treatment and drug use. A nascent line of research concerns predictive modeling of healthcare data for the automatic detection of adverse drug events, which presents its own set of challenges: it is not yet clear how to represent the heterogeneous data types in a manner conducive to learning high-performing machine learning models. Methods Datasets from an electronic health record database are used for learning predictive models with the purpose of detecting adverse drug events. The use and representation of two data types, as well as their combination, are studied: clinical codes, describing prescribed drugs and assigned diagnoses, and measurements. Feature selection is conducted on the various types of data to reduce dimensionality and sparsity, while allowing for an in-depth feature analysis of the usefulness of each data type and representation. Results Within each data type, combining multiple representations yields better predictive performance compared to using any single representation. The use of clinical codes for adverse drug event detection significantly outperforms the use of measurements; however, there is no significant difference over datasets between using only clinical codes and their combination with measurements. For certain adverse drug events, the combination does, however, outperform using only clinical codes. Feature selection leads to increased predictive performance for both data types, in isolation and combined. Conclusions We have demonstrated how machine learning can be applied to electronic health records for the purpose of detecting adverse drug events and proposed solutions to some of the challenges this presents, including how to represent the various data types. Overall, clinical codes are more useful than measurements and, in specific cases, it is beneficial to combine the two. PMID:26606038

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)

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.

High agreement between the new Mongolian electronic immunization register and written immunization records: a health centre based audit

PubMed Central

Mungun, Tuya; Dorj, Narangerel; Volody, Baigal; Chuluundorj, Uranjargal; Munkhbat, Enkhtuya; Danzan, Gerelmaa; Nguyen, Cattram D; La Vincente, Sophie; Russell, Fiona

2017-01-01

Introduction Monitoring of vaccination coverage is vital for the prevention and control of vaccine-preventable diseases. Electronic immunization registers have been increasingly adopted to assist with the monitoring of vaccine coverage; however, there is limited literature about the use of electronic registers in low- and middle-income countries such as Mongolia. We aimed to determine the accuracy and completeness of the newly introduced electronic immunization register for calculating vaccination coverage and determining vaccine effectiveness within two districts in Mongolia in comparison to written health provider records. Methods We conducted a cross-sectional record review among children 2–23 months of age vaccinated at immunization clinics within the two districts. We linked data from written records with the electronic immunization register using the national identification number to determine the completeness and accuracy of the electronic register. Results Both completeness (90.9%; 95% CI: 88.4–93.4) and accuracy (93.3%; 95% CI: 84.1–97.4) of the electronic immunization register were high when compared to written records. The increase in completeness over time indicated a delay in data entry. Conclusion Through this audit, we have demonstrated concordance between a newly introduced electronic register and health provider records in a middle-income country setting. Based on this experience, we recommend that electronic registers be accompanied by routine quality assurance procedures for the monitoring of vaccination programmes in such settings. PMID:29051836

[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.

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.

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.

[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.

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

PubMed

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

2001-01-01

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

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...

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.

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 9 2014-07-01 2014-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 9 2011-07-01 2011-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 9 2012-07-01 2012-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 9 2013-07-01 2013-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

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.

Electronic Health Record Implementation: A SWOT Analysis.

PubMed

Shahmoradi, Leila; Darrudi, Alireza; Arji, Goli; Farzaneh Nejad, Ahmadreza

2017-10-01

Electronic Health Record (EHR) is one of the most important achievements of information technology in healthcare domain, and if deployed effectively, it can yield predominant results. The aim of this study was a SWOT (strengths, weaknesses, opportunities, and threats) analysis in electronic health record implementation. This is a descriptive, analytical study conducted with the participation of a 90-member work force from Hospitals affiliated to Tehran University of Medical Sciences (TUMS). The data were collected by using a self-structured questionnaire and analyzed by SPSS software. Based on the results, the highest priority in strength analysis was related to timely and quick access to information. However, lack of hardware and infrastructures was the most important weakness. Having the potential to share information between different sectors and access to a variety of health statistics was the significant opportunity of EHR. Finally, the most substantial threats were the lack of strategic planning in the field of electronic health records together with physicians' and other clinical staff's resistance in the use of electronic health records. To facilitate successful adoption of electronic health record, some organizational, technical and resource elements contribute; moreover, the consideration of these factors is essential for HER implementation.

Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.

PubMed

Gold, Jeffrey Allen; Stephenson, Laurel E; Gorsuch, Adriel; Parthasarathy, Keshav; Mohan, Vishnu

2016-09-01

Numerous reports describe unintended consequences of electronic health record implementation. Having previously described physicians' failures to recognize patient safety issues within our electronic health record simulation environment, we now report on our use of eye and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. We linked performance on the simulation to standard eye and screen-tracking readouts including number of fixations, saccades, mouse clicks and screens visited. In addition, we developed an overall Composite Eye Tracking score which measured when, where and how often each safety item was viewed. For 39 participants, the Composite Eye Tracking score correlated with performance on the simulation (p = 0.004). Overall, the improved performance was associated with a pattern of rapid scanning of data manifested by increased number of screens visited (p = 0.001), mouse clicks (p = 0.03) and saccades (p = 0.004). Eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability. © The Author(s) 2015.

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

PubMed

Herbert, Valerie M; Connors, Helen

2016-08-01

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

Tamper indicating bolt

DOEpatents

Blagin, Sergei V.; Barkanov, Boris P.

2004-09-14

A tamper-indicating fastener has a cylindrical body with threads extending from one end along a portion of the body, and a tamper indicating having a transducer for converting physical properties of the body into electronic data; electronics for recording the electronic data; and means for communicating the recorded information to a remote location from said fastener. The electronics includes a capacitor that varies as a function of force applied by the fastener, and non-volatile memory for recording instances when the capacitance varies, providing an indication of unauthorized access.

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.

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

GSFC specification electronic data processing magnetic recording tape

NASA Technical Reports Server (NTRS)

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

1980-01-01

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

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.

Payload and Components Real-Time Automated Test System (PACRATS), Data Acquisition of Leak Rate and Pressure Data Test Procedure

NASA Technical Reports Server (NTRS)

Rinehart, Maegan L.

2011-01-01

The purpose of this activity is to provide the Mechanical Components Test Facility (MCTF) with the capability to obtain electronic leak test and proof pressure data, Payload and Components Real-time Automated Test System (PACRATS) data acquisition software will be utilized to display real-time data. It will record leak rates and pressure/vacuum level(s) simultaneously. This added functionality will provide electronic leak test and pressure data at specified sampling frequencies. Electronically stored data will provide ES61 with increased data security, analysis, and accuracy. The tasks performed in this procedure are to verify PACRATS only, and are not intended to provide verifications for MCTF equipment.

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.

New Help for the Handicapped

NASA Technical Reports Server (NTRS)

1984-01-01

L & M Electronics, Inc.'s telemetry system is used to measure degree and location of abnormal muscle activity. This telemetry was originally used to monitor astronauts vital functions. Leg sensors send wireless signals to computer which develops pictures of gait patterns. System records, measures and analyzes muscle activities in limbs and spine. Computer developed pictures of gait patterns help physicians determine potential of corrective surgery, evaluate various types of braces, or decide whether physical therapy may improve motor functions.

Neuroengineering control and regulation of behavior

NASA Astrophysics Data System (ADS)

Wróbel, A.; Radzewicz, C.; Mankiewicz, L.; Hottowy, P.; Knapska, E.; Konopka, W.; Kublik, E.; Radwańska, K.; Waleszczyk, W. J.; Wójcik, D. K.

2014-11-01

To monitor neuronal circuits involved in emotional modulation of sensory processing we proposed a plan to establish novel research techniques combining recent biological, technical and analytical discoveries. The project was granted by National Science Center and we started to build a new experimental model for studying the selected circuits of genetically marked and behaviorally activated neurons. To achieve this goal we will combine the pioneering, interdisciplinary expertise of four Polish institutions: (i) the Nencki Institute of Experimental Biology (Polish Academy of Sciences) will deliver the expertise on genetically modified mice and rats, mapping of the neuronal circuits activated by behavior, monitoring complex behaviors measured in the IntelliCage system, electrophysiological brain activity recordings by multielectrodes in behaving animals, analysis and modeling of behavioral and electrophysiological data; (ii) the AGH University of Science and Technology (Faculty of Physics and Applied Computer Sciences) will use its experience in high-throughput electronics to build multichannel systems for recording the brain activity of behaving animals; (iii) the University of Warsaw (Faculty of Physics) and (iv) the Center for Theoretical Physics (Polish Academy of Sciences) will construct optoelectronic device for remote control of opto-animals produced in the Nencki Institute based on the unique experience in laser sources, studies of light propagation and its interaction with condensed media, wireless medical robotic systems, fast readout opto-electronics with control software and micromechanics.

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.

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.

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

PubMed Central

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

2003-01-01

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

The electronic medical record in dermatology.

PubMed

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

2010-09-01

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

EMERSE: The Electronic Medical Record Search Engine

PubMed Central

Hanauer, David A.

2006-01-01

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

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

PubMed

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

2016-03-05

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

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.

Analysis of strong scintillation events by using GPS data at low latitudes

NASA Astrophysics Data System (ADS)

Forte, Biagio; Jakowski, Norbert; Wilken, Volker

2010-05-01

Drifting structures charaterised by inhomogeneities in the spatial electron density distribution at ionospheric heights originate scintillation of radio waves propagating through. The fractional electron density fluctuations and the corresponding scintillation levels may reach extreme values at low latitudes during high solar activity. Strong scintillation events have disruptive effects on a number of technological applications. In particular, operations and services based on GPS signals and receivers may experience severe disruption due to a significant degradation of the signal-to-noise ratio, eventually leading to signal loss of lock. Experimental scintillation data collected in the Asian sector at low latitudes by means of a GPS dual frequency receiver under moderate solar activity (2006) have been analysed. The GPS receiver is particularly modified in firmware in order to record power estimates on the C/A code as well as on the carriers L1 and L2. Strong scintillation activity is recorded in the post-sunset period (saturating S4 and SI as high as 20 dB). An overview of these events is presented, by taking into account scintillation impact on the signal intensity, phase, and dynamics. In particular, the interpretation of these events based on a refined scattering theory is provided with possible consequences for standard scintillation models.

Nurses and electronic health records in a Canadian hospital: examining the social organisation and programmed use of digitised nursing knowledge.

PubMed

Campbell, Marie L; Rankin, Janet M

2017-03-01

Institutional ethnography (IE) is used to examine transformations in a professional nurse's work associated with her engagement with a hospital's electronic health record (EHR) which is being updated to integrate professional caregiving and produce more efficient and effective health care. We review in the technical and scholarly literature the practices and promises of information technology and, especially of its applications in health care, finding useful the more critical and analytic perspectives. Among the latter, scholarship on the activities of economising is important to our inquiry into the actual activities that transform 'things' (in our case, nursing knowledge and action) into calculable information for objective and financially relevant decision-making. Beginning with an excerpt of observational data, we explicate observed nurse-patient interactions, discovering in them traces of institutional ruling relations that the nurse's activation of the EHR carries into the nursing setting. The EHR, we argue, materialises and generalises the ruling relations across institutionally located caregivers; its authorised information stabilises their knowing and acting, shaping health care towards a calculated effective and efficient form. Participating in the EHR's ruling practices, nurses adopt its ruling standpoint; a transformation that we conclude needs more careful analysis and debate. © 2016 Foundation for the Sociology of Health & Illness.

29 CFR 1209.08 - Transcripts, recordings or minutes of closed meetings; retention; public availability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... provisions of 5 U.S.C. 552b(c), copies of transcripts or minutes, or transcriptions of electronic recordings... transcription. Requests for copies of transcripts or minutes, or transcriptions of electronic recordings of...

78 FR 21314 - Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

... health records software or information technology and training services. The final rule for this safe... health records software or information technology and training services. In the same issue of the Federal..., licenses, and intellectual property related to electronic health records software; connectivity services...

Thermoluminescence study of X-ray and UV irradiated natural calcite and analysis of its trap and recombination level.

PubMed

Kalita, J M; Wary, G

2014-05-05

Thermoluminescence (TL) of natural light-orange color calcite (CaCO3) mineral in micro-grain powder form was studied at room temperature X-ray and UV irradiation under various irradiation times. TL was recorded in linear heating rate (2 K/s) from room temperature (300 K) to 523 K. Trapping parameters such as activation energy, order of kinetics, frequency factor have been evaluated by Computerized Glow Curve Deconvolution technique. Three electron trap centers had been estimated at depth 0.70, 1.30 and 1.49 eV from the conduction band. Investigation of emission spectra recorded at various temperatures showed single recombination center at depth 2.74 eV from the conduction band. Due to thermally assisted tunneling of electron and subsequent center-to-center recombination, a distinct peak of lower activation energy (0.60 eV) was observed at relatively higher temperature (~360 K) for X-ray irradiated sample. In UV excitation, there was an indication of photo-transfer phenomenon, where low TL intensity might have been observed; but due to simultaneous excitation of electrons from valence band to the trap level, TL intensity was found to increase with UV irradiation time. The results obtained within temperature range 300-523 K were explained by considering a band diagram. Copyright © 2014 Elsevier B.V. All rights reserved.

Real-Time Risk Prediction on the Wards: A Feasibility Study.

PubMed

Kang, Michael A; Churpek, Matthew M; Zadravecz, Frank J; Adhikari, Richa; Twu, Nicole M; Edelson, Dana P

2016-08-01

Failure to detect clinical deterioration in the hospital is common and associated with poor patient outcomes and increased healthcare costs. Our objective was to evaluate the feasibility and accuracy of real-time risk stratification using the electronic Cardiac Arrest Risk Triage score, an electronic health record-based early warning score. We conducted a prospective black-box validation study. Data were transmitted via HL7 feed in real time to an integration engine and database server wherein the scores were calculated and stored without visualization for clinical providers. The high-risk threshold was set a priori. Timing and sensitivity of electronic Cardiac Arrest Risk Triage score activation were compared with standard-of-care Rapid Response Team activation for patients who experienced a ward cardiac arrest or ICU transfer. Three general care wards at an academic medical center. A total of 3,889 adult inpatients. The system generated 5,925 segments during 5,751 admissions. The area under the receiver operating characteristic curve for electronic Cardiac Arrest Risk Triage score was 0.88 for cardiac arrest and 0.80 for ICU transfer, consistent with previously published derivation results. During the study period, eight of 10 patients with a cardiac arrest had high-risk electronic Cardiac Arrest Risk Triage scores, whereas the Rapid Response Team was activated on two of these patients (p < 0.05). Furthermore, electronic Cardiac Arrest Risk Triage score identified 52% (n = 201) of the ICU transfers compared with 34% (n = 129) by the current system (p < 0.001). Patients met the high-risk electronic Cardiac Arrest Risk Triage score threshold a median of 30 hours prior to cardiac arrest or ICU transfer versus 1.7 hours for standard Rapid Response Team activation. Electronic Cardiac Arrest Risk Triage score identified significantly more cardiac arrests and ICU transfers than standard Rapid Response Team activation and did so many hours in advance.

Naturalistic Observation of Health-Relevant Social Processes: The Electronically Activated Recorder (EAR) Methodology in Psychosomatics

PubMed Central

Mehl, Matthias R.; Robbins, Megan L.; Deters, Fenne große

2012-01-01

This article introduces a novel, observational ambulatory monitoring method called the Electronically Activated Recorder or EAR. The EAR is a digital audio recorder that runs on a handheld computer and periodically and unobtrusively records snippets of ambient sounds from participants’ momentary environments. In tracking moment-to-moment ambient sounds, it yields acoustic logs of people’s days as they naturally unfold. In sampling only a fraction of the time, it protects participants’ privacy and makes large observational studies feasible. As a naturalistic observation method, it provides an observer’s account of daily life and is optimized for the objective assessment of audible aspects of social environments, behaviors, and interactions (e.g., habitual preferences for social settings, idiosyncratic interaction styles, and subtle emotional expressions). The article discusses the EAR method conceptually and methodologically, reviews prior research with it, and identifies three concrete ways in which it can enrich psychosomatic research. Specifically, it can (a) calibrate psychosocial effects on health against frequencies of real-world behavior, (b) provide ecological, observational measures of health-related social processes that are independent of self-report, and (c) help with the assessment of subtle and habitual social behaviors that evade self-report but have important health implications. An important avenue for future research lies in merging traditional, self-report based ambulatory monitoring methods with observational approaches such as the EAR to allow for the simultaneous yet methodologically independent assessment of inner, experiential (e.g., loneliness) and outer, observable aspects (e.g., social isolation) of real-world social processes to reveal their unique effects on health. PMID:22582338

Naturalistic observation of health-relevant social processes: the electronically activated recorder methodology in psychosomatics.

PubMed

Mehl, Matthias R; Robbins, Megan L; Deters, Fenne Große

2012-05-01

This article introduces a novel observational ambulatory monitoring method called the electronically activated recorder (EAR). The EAR is a digital audio recorder that runs on a handheld computer and periodically and unobtrusively records snippets of ambient sounds from participants' momentary environments. In tracking moment-to-moment ambient sounds, it yields acoustic logs of people's days as they naturally unfold. In sampling only a fraction of the time, it protects participants' privacy and makes large observational studies feasible. As a naturalistic observation method, it provides an observer's account of daily life and is optimized for the objective assessment of audible aspects of social environments, behaviors, and interactions (e.g., habitual preferences for social settings, idiosyncratic interaction styles, subtle emotional expressions). This article discusses the EAR method conceptually and methodologically, reviews prior research with it, and identifies three concrete ways in which it can enrich psychosomatic research. Specifically, it can (a) calibrate psychosocial effects on health against frequencies of real-world behavior; (b) provide ecological observational measures of health-related social processes that are independent of self-report; and (c) help with the assessment of subtle and habitual social behaviors that evade self-report but have important health implications. An important avenue for future research lies in merging traditional self-report-based ambulatory monitoring methods with observational approaches such as the EAR to allow for the simultaneous yet methodologically independent assessment of inner, experiential aspects (e.g., loneliness) and outer, observable aspects (e.g., social isolation) of real-world social processes to reveal their unique effects on health.

Improving Notification of Sexually Transmitted Infections: A Quality Improvement Project and Planned Experiment

PubMed Central

Reed, Jennifer L.; Munafo, Jennifer Knopf; Ekstrand, Rachel; Gillespie, Gordon; Holland, Carolyn; Britto, Maria T.

2012-01-01

BACKGROUND AND OBJECTIVE: Inadequate follow-up of positive sexually transmitted infection (STI) test results is a gap in health care quality that contributes to the epidemic of STIs in adolescent women. The goal of this study was to improve our ability to contact adolescent women with positive STI test results after an emergency department visit. METHODS: We conducted an interventional quality improvement project at a pediatric emergency department. Phase 1 included plan-do-study-act cycles to test interventions such as provider education and system changes. Phase 2 was a planned experiment studying 2 interventions (study cell phone and patient activation card), using a 2 × 2 factorial design with 1 background variable and 2 replications. Outcomes were: (1) the proportion of women aged 14 to 21 years with STI testing whose confidential telephone number was documented in the electronic medical record; (2) the proportion of STI positive women successfully contacted within 7 days. RESULTS: Phase 1 interventions increased the proportion of records with a confidential number from 24% to 58% and the proportion contacted from 45% to 65%, and decreased loss to follow-up from 40% to 24%. In phase 2, the proportion contacted decreased after the electronic medical record system changed and recording of the confidential number decreased. Study interventions (patient activation card and study cell phone) had a synergistic effect on successful contact, especially when confidential numbers were less reliably documented. CONCLUSIONS: Feasible and sustainable interventions such as improved documentation of a confidential number worked synergistically to increase our ability to successfully contact adolescent women with their STI test results. PMID:22753557

Selection and Implementation of a Simulated Electronic Medical Record (EMR) in a Nursing Skills Lab

ERIC Educational Resources Information Center

Curry, David G.

2011-01-01

SUNY Plattsburgh has a baccalaureate nursing program that has been active in integrating technology in nursing education for many years. Recently, the faculty implemented human simulation (Laerdal's SimMan) in the Nursing Skills Lab (NSL) to provide some uniform clinical experiences (high frequency or high risk scenarios) not always available in…

[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.

Controversial electronic structures and energies of Fe{sub 2}, Fe{sub 2}{sup +}, and Fe{sub 2}{sup −} resolved by RASPT2 calculations

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

Hoyer, Chad E.; Manni, Giovanni Li; Truhlar, Donald G., E-mail: truhlar@umn.edu, E-mail: gagliard@umn.edu

2014-11-28

The diatomic molecule Fe{sub 2} was investigated using restricted active space second-order perturbation theory (RASPT2). This molecule is very challenging to study computationally because predictions about the ground state and excited states depend sensitively on the choice of the quantum chemical method. For Fe{sub 2} we show that one needs to go beyond a full-valence active space in order to achieve even qualitative agreement with experiment for the dissociation energy, and we also obtain a smooth ground-state potential curve. In addition we report the first multireference study of Fe{sub 2}{sup +}, for which we predict an {sup 8}Σ{sub u}{sup −}more » ground state, which was not predicted by previous computational studies. By using an active space large enough to remove the most serious deficiencies of previous theoretical work and by explicitly investigating the interpretations of previous experimental results, this study elucidates previous difficulties and provides – for the first time – a qualitatively correct treatment of Fe{sub 2}, Fe{sub 2}{sup +}, and Fe{sub 2}{sup −}. Moreover, this study represents a record in terms of the number or active electrons and active orbitals in the active space, namely 16 electrons in 28 orbitals. Conventional CASPT2 calculations can be performed with at most 16 electrons in 16 orbitals. We were able to overcome this limit by using the RASPT2 formalism.« less

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.

Active pharmacovigilance in China: recent development and future perspectives.

PubMed

Li, Xinling; Li, Haona; Deng, Jianxiong; Zhu, Feng; Liu, Ying; Chen, Wenge; Yue, Zhihua; Ren, Xuequn; Xia, Jielai

2018-04-10

The effectiveness of active pharmacovigilance depends on the specific methods adopted and the work patterns put into place. Over the past few years, much attention has been paid to the importance of implementing such systems in China. However, less has been done to evaluate the state of implementation and future needs of such systems. This paper reviews China's recent approaches to active pharmacovigilance by examining: (1) information collected from scientific articles and the websites of the China Food and Drug Administration and the China National Center for Adverse Drug Reaction Monitoring, (2) information available on China's spontaneous reporting systems (SRS) and active pharmacovigilance system, and (3) annual reports and internal reports on this subject. Areas that improved most meaningfully for China's active pharmacovigilance in recent years appear to include: (1) quicker reporting and more intelligent scanning methods for adverse drug reactions (ADRs), (2) the use of pharmacovigilance approaches to mine electronic hospital records, and (3) the development of integrated systems including the China Hospital Pharmacovigilance System and China Sentinel Hospital Alliance Program. Not only has the national online SRS system provided a platform for passive pharmacovigilance, it has also become an important platform for various explorations of active pharmacovigilance in China. Quick reporting and intelligent scanning of ADRs, facilitated by automated ADR detection based on electronic hospital records, have accelerated to capabilities for active pharmacovigilance. The outcomes of the programs, such as the China Hospital Pharmacovigilance System and China Sentinel Hospital Alliance Program, usher in a new era for China's active pharmacovigilance. These are particularly important to bridge the information system of sentinel hospitals and ADR research centers, but gaps remain. Thus, much work needs to be done before a high-level active pharmacovigilance system is sufficiently mature to ensure drug safety in the country.

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

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.

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

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

PubMed

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

2014-06-01

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

A Distributed Amplifier System for Bilayer Lipid Membrane (BLM) Arrays With Noise and Individual Offset Cancellation.

PubMed

Crescentini, Marco; Thei, Frederico; Bennati, Marco; Saha, Shimul; de Planque, Maurits R R; Morgan, Hywel; Tartagni, Marco

2015-06-01

Lipid bilayer membrane (BLM) arrays are required for high throughput analysis, for example drug screening or advanced DNA sequencing. Complex microfluidic devices are being developed but these are restricted in terms of array size and structure or have integrated electronic sensing with limited noise performance. We present a compact and scalable multichannel electrophysiology platform based on a hybrid approach that combines integrated state-of-the-art microelectronics with low-cost disposable fluidics providing a platform for high-quality parallel single ion channel recording. Specifically, we have developed a new integrated circuit amplifier based on a novel noise cancellation scheme that eliminates flicker noise derived from devices under test and amplifiers. The system is demonstrated through the simultaneous recording of ion channel activity from eight bilayer membranes. The platform is scalable and could be extended to much larger array sizes, limited only by electronic data decimation and communication capabilities.

Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs.

PubMed

Tartaglia, Alexander; Dodd-McCue, Diane; Ford, Timothy; Demm, Charles; Hassell, Alma

2016-01-01

This study explores the extent to which chaplaincy departments at ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training. Survey data solicited from 219 programs with a 45% response rate and interview findings from 11 centers demonstrate a high level of usage of the EMR as well as an expectation that CPE residents document each patient/family encounter. Centers provided considerable initial training, but less ongoing monitoring of chaplain documentation. Centers used multiple sources to develop documentation tools for the EMR. One center was verified as having created the spiritual assessment component of the documentation tool from a peer reviewed published model. Interviews found intermittent use of the student chart notes for educational purposes. One center verified a structured manner of monitoring chart notes as a performance improvement activity. Findings suggested potential for the development of a standard documentation tool for chaplain charting and training.

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.

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.

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.

Annotations for the Collaboration of the Health Professionals

PubMed Central

Bringay, Sandra; Barry, Catherine; Charlet, Jean

2006-01-01

In the French DocPatient project, we work on documentary functionalities to improve the use of the electronic medical record. We suggest that integration of specific uses for paper medical documents in the design of the electronic medical record will improve its utility, use and acceptance. We propose in this paper to add a functionality of annotations in the electronic medical record to reinforce collaboration, coordination and awareness. PMID:17238309

EMERSE: The Electronic Medical Record Search Engine

PubMed Central

Hanauer, David A.

2006-01-01

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

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

PubMed

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

2013-11-01

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

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.

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.

Quantifying the Hawthorne Effect in Hand Hygiene Compliance Through Comparing Direct Observation With Automated Hand Hygiene Monitoring.

PubMed

Hagel, Stefan; Reischke, Jana; Kesselmeier, Miriam; Winning, Johannes; Gastmeier, Petra; Brunkhorst, Frank M; Scherag, André; Pletz, Mathias W

2015-08-01

To quantify the Hawthorne effect of hand hygiene performance among healthcare workers using direct observation. Prospective observational study. Intensive care unit, university hospital. Direct observation of hand hygiene compliance over 48 audits of 2 hours each. Simultaneously, hand hygiene events (HHEs) were recorded using electronic alcohol-based handrub dispensers. Directly observed and electronically recorded HHEs during the 2 hours of direct observation were compared using Spearman correlations and Bland-Altman plots. To quantify the Hawthorne effect, we compared the number of electronically recorded HHEs during the direct observation periods with the re-scaled electronically recorded HHEs in the 6 remaining hours of the 8-hour working shift. A total of 3,978 opportunities for hand hygiene were observed during the 96 hours of direct observation. Hand hygiene compliance was 51% (95% CI, 49%-53%). There was a strong positive correlation between directly observed compliance and electronically recorded HHEs (ρ=0.68 [95% CI, 0.49-0.81], P<.0001). In the 384 hours under surveillance, 4,180 HHEs were recorded by the electronic dispensers. Of those, 2,029 HHEs were recorded during the 96 hours in which direct observation was also performed, and 2,151 HHEs were performed in the remaining 288 hours of the same working shift that were not under direct observation. Healthcare workers performed 8 HHEs per hour when not under observation compared with 21 HHEs per hour during observation. Directly and electronically observed HHEs were in agreement. We observed a marked influence of the Hawthorne effect on hand hygiene performance.

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

PubMed

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

2016-01-01

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

17 CFR 147.9 - Requests for copies of transcripts, recordings or minutes of closed meetings.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., recordings or minutes of closed meetings. (a) Copies of a transcript transcription of an electronic recording... § 147.8(a), shall be furnished to any person at the actual cost of duplication or transcription pursuant...)(9), (d) and (e). (b) Requests for copies of transcripts, transcriptions of electronic recordings or...

17 CFR 147.9 - Requests for copies of transcripts, recordings or minutes of closed meetings.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., recordings or minutes of closed meetings. (a) Copies of a transcript transcription of an electronic recording... § 147.8(a), shall be furnished to any person at the actual cost of duplication or transcription pursuant...)(9), (d) and (e). (b) Requests for copies of transcripts, transcriptions of electronic recordings or...

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.

An Autonomous Underwater Recorder Based on a Single Board Computer.

PubMed

Caldas-Morgan, Manuel; Alvarez-Rosario, Alexander; Rodrigues Padovese, Linilson

2015-01-01

As industrial activities continue to grow on the Brazilian coast, underwater sound measurements are becoming of great scientific importance as they are essential to evaluate the impact of these activities on local ecosystems. In this context, the use of commercial underwater recorders is not always the most feasible alternative, due to their high cost and lack of flexibility. Design and construction of more affordable alternatives from scratch can become complex because it requires profound knowledge in areas such as electronics and low-level programming. With the aim of providing a solution; a well succeeded model of a highly flexible, low-cost alternative to commercial recorders was built based on a Raspberry Pi single board computer. A properly working prototype was assembled and it demonstrated adequate performance levels in all tested situations. The prototype was equipped with a power management module which was thoroughly evaluated. It is estimated that it will allow for great battery savings on long-term scheduled recordings. The underwater recording device was successfully deployed at selected locations along the Brazilian coast, where it adequately recorded animal and manmade acoustic events, among others. Although power consumption may not be as efficient as that of commercial and/or micro-processed solutions, the advantage offered by the proposed device is its high customizability, lower development time and inherently, its cost.

77 FR 65416 - Advisory Committee on the Electronic Records Archives (ACERA)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... Minutes ERA Program Update Business Priorities Presidential Directive on Records Management Online Public Access Discussions: Encouraging development of automated tools for electronic records management, impact of big data, and benchmarking Dated: October 24, 2012. Patrice Little Murray, Acting Committee...

Standard of care of erectile dysfunction in U.S. Air Force aircrew and active duty not on flying status.

PubMed

Nast, Justin B

2014-11-01

In 2011, over 3,000 active duty U.S. Air Force (USAF) members were prescribed a phosphodiesterase inhibitor (PDEI). PDEIs are first-line therapy for treating erectile dysfunction and can have significant side effects that could impact aircrew performance. In total, 200 eligible subject records were randomly sampled from the active duty USAF population of those males filling a prescription for a PDEI in June 2011; 100 of those records were from aviators. The electronic records were reviewed and scored to determine if USAF aeromedical standards for prescribing PDEIs were followed, with a minimum score of 0 for no standards met and a maximum of 3 for all standards met. The average score for both groups was 1, with no significant difference between the group scores. A proper aeromedical disposition was documented in 67% of the aviator records. Although there was no significant difference in standard of care for aviators and nonaviators, the overall documented standard of care was poor. Lack of documentation was the primary reason for the low scores and the low percentage of properly rendered aeromedical dispositions. Proper medical record documentation is important for evaluating quality of care and ensuring compliance with regulations in an Air Force aviator population. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

21 CFR 11.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SIGNATURES General Provisions § 11.1 Scope. (a) The regulations in this part set forth the criteria under which the agency considers electronic records, electronic signatures, and handwritten signatures... handwritten signatures executed on paper. (b) This part applies to records in electronic form that are created...

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...

How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals.

PubMed

de Jong, Catharina C; Ros, Wynand Jg; van Leeuwen, Mia; Schrijvers, Guus

2016-11-24

Home-dwelling elderly patients with multimorbidity are at risk of fragmentation of care because of the many different professionals involved and a potentially unclear level of communication. Multidisciplinary communication seems to occur incidentally. Mutual feedback is needed for a professional team to provide consistent care and adequate support to the patient system. eHealth technology can improve outcomes. The aim of this study was to evaluate the use of a tool, Congredi, for electronic communication by professionals for the care of home-dwelling elderly patients. The research group was recruited through general practices and home care organizations. Congredi, a tool designed for multidisciplinary communication, was made available for professionals in primary care. It consists of a care plan and a communication channel (secure emailing). Professionals opened Congredi records for elderly patients who had 2 or more professionals involved. The records were the unit of analysis. Data were gathered from the Congredi system over a period of 42 weeks. An inclusion rate of 21.4% (203/950) was achieved; nearly half of the participants were nurses. During the study, professionals were active in 448 patient records; female professionals were prevalent. In the patient records, 3 types of actions (care activities, emailing, and process activities) were registered. Most activities occurred in the multidisciplinary records (mean 12.2), which had twice the number of activities of monodisciplinary records (6.35), and solo records had a mean of 3.43 activities. Most activities were care activities (mean 9.14), emailing had a mean of 0.89 activities, and process activities had a mean of 0.29. An e-communication tool (Congredi) was usable for improving multidisciplinary communication among professionals. It even seemed to yield results for 40% of the professionals who used the e-care plan on their own. The content of the tool provided an active communication practice, with significant increases observed in the actions that must be shared for the effective coordination of care. ©Catharina C de Jong, Wynand JG Ros, Mia van Leeuwen, Guus Schrijvers. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.11.2016.

Recent Advances in Optically Controlled Bulk Semiconductor Switches

DTIC Science & Technology

1985-06-01

REO!NT AIJifl,NCES IN (FTICALIX ~1Ra.LW IILK SHttiaHlOCIOR swrrams L. Bovino , T. Burke, R. Youmans, M. Weiner, J. Carter U.S. Ar~ Electronics...fabrication of all of our optically activated switches. B.e.fer.enc.es. 1. L. Bovino , R. Youmans, T. Burke, M.Weiner, "Modulator Circuits Using Q...tically Activated Switches", Record of 16th Power Modulator SYJll>o- siurn, pp 235-239, June 1984. 2. M. Weiner, T. Burke, R. Youmans, L. Bovino , J

CCM-C,Collins checks the middeck experiment

NASA Image and Video Library

1999-07-24

S93-E-5016 (23 July 1999) --- Astronaut Eileen M. Collins, mission commander, checks on an experiment on Columbia's middeck during Flight Day 1 activity. The experiment is called the Cell Culture Model, Configuration C. Objectives of it are to validate cell culture models for muscle, bone and endothelial cell biochemical and functional loss induced by microgravity stress; to evaluate cytoskeleton, metabolism, membrane integrity and protease activity in target cells; and to test tissue loss pharmaceuticals for efficacy. The photo was recorded with an electronic still camera (ESC).

Mobile Diabetes Management for USAF Active and Retired Military Spouses: Lessons Learned in the Integration of Mobile Integrated Therapies (MIT) into Electronic Medical Records (EMR)

DTIC Science & Technology

2013-09-24

episodic testing, activity, nutrition , etc.) asynchronously throughout any given day, and to recall the correct (and often complex) medication and/or...instructions as much as 50% of the time13. In a dynamic world, patients need dynamic access to relevant and timely education outside of their healthcare...which provides adults with type 2 diabetes real-time, contextually relevant coaching and education . This automated feedback is tailored to the

Automatic lightning detection and photographic system

NASA Technical Reports Server (NTRS)

Wojtasinski, R. J.; Holley, L. D.; Gray, J. L.; Hoover, R. B. (Inventor)

1972-01-01

A system is presented for monitoring and recording lightning strokes within a predetermined area with a camera having an electrically operated shutter with means for advancing the film in the camera after activating the shutter. The system includes an antenna for sensing lightning strikes which, in turn, generates a signal that is fed to an electronic circuit which generates signals for operating the shutter of the camera. Circuitry is provided for preventing activation of the shutter as the film in the camera is being advanced.

Invasive blood pressure recording comparing nursing charts with an electronic monitor: a technical report.

PubMed

Wong, Benjamin T; Glassford, Neil J; Bion, Victoria; Chai, Syn Y; Bellomo, Rinaldo

2014-03-01

Blood pressure management (assessed using nursing charts) in the early phase of septic shock may have an effect on renal outcomes. Assessment of mean arterial pressure (MAP) values as recorded on nursing charts may be inaccurate. To determine the difference between hourly blood pressure values as recorded on the nursing charts and hourly average blood pressure values over the corresponding period obtained electronically from the bedside monitor. We studied 20 patients with shock requiring vasopressor support and invasive blood pressure monitoring. Hourly blood pressure measurements were recorded on the nursing charts over a 12-hour period. Blood pressure values recorded every 10 minutes were downloaded from electronic patient monitors over the corresponding period. The hourly average of the 10-minute blood pressure values was compared with the measurements recorded on the nursing charts. We assessed 240 chart readings and 1440 electronic recordings. Average chart MAP was 72.54 mmHg and average electronic monitor MAP was 71.54 mmHg. MAP data from the two sources showed a strong correlation (ρ0.71, P < 0.005). Bland-Altman assessment revealed acceptable agreement, with a mean bias of 1mmHg and 95% limits of agreement of -11.76 mmHg and 13.76 mmHg. Using average data over 6 hours, 95% limits of agreement narrowed to -6.79mmHg and 8.79mmHg. With multiple measurements over time, mean blood pressure as recorded on nursing charts reasonably approximates mean blood pressure recorded on the monitor.

Syringe-injectable mesh electronics integrate seamlessly with minimal chronic immune response in the brain

PubMed Central

Zhou, Tao; Hong, Guosong; Fu, Tian-Ming; Yang, Xiao; Schuhmann, Thomas G.; Viveros, Robert D.; Lieber, Charles M.

2017-01-01

Implantation of electrical probes into the brain has been central to both neuroscience research and biomedical applications, although conventional probes induce gliosis in surrounding tissue. We recently reported ultraflexible open mesh electronics implanted into rodent brains by syringe injection that exhibit promising chronic tissue response and recording stability. Here we report time-dependent histology studies of the mesh electronics/brain-tissue interface obtained from sections perpendicular and parallel to probe long axis, as well as studies of conventional flexible thin-film probes. Confocal fluorescence microscopy images of the perpendicular and parallel brain slices containing mesh electronics showed that the distribution of astrocytes, microglia, and neurons became uniform from 2–12 wk, whereas flexible thin-film probes yield a marked accumulation of astrocytes and microglia and decrease of neurons for the same period. Quantitative analyses of 4- and 12-wk data showed that the signals for neurons, axons, astrocytes, and microglia are nearly the same from the mesh electronics surface to the baseline far from the probes, in contrast to flexible polymer probes, which show decreases in neuron and increases in astrocyte and microglia signals. Notably, images of sagittal brain slices containing nearly the entire mesh electronics probe showed that the tissue interface was uniform and neurons and neurofilaments penetrated through the mesh by 3 mo postimplantation. The minimal immune response and seamless interface with brain tissue postimplantation achieved by ultraflexible open mesh electronics probes provide substantial advantages and could enable a wide range of opportunities for in vivo chronic recording and modulation of brain activity in the future. PMID:28533392

Syringe-injectable mesh electronics integrate seamlessly with minimal chronic immune response in the brain.

PubMed

Zhou, Tao; Hong, Guosong; Fu, Tian-Ming; Yang, Xiao; Schuhmann, Thomas G; Viveros, Robert D; Lieber, Charles M

2017-06-06

Implantation of electrical probes into the brain has been central to both neuroscience research and biomedical applications, although conventional probes induce gliosis in surrounding tissue. We recently reported ultraflexible open mesh electronics implanted into rodent brains by syringe injection that exhibit promising chronic tissue response and recording stability. Here we report time-dependent histology studies of the mesh electronics/brain-tissue interface obtained from sections perpendicular and parallel to probe long axis, as well as studies of conventional flexible thin-film probes. Confocal fluorescence microscopy images of the perpendicular and parallel brain slices containing mesh electronics showed that the distribution of astrocytes, microglia, and neurons became uniform from 2-12 wk, whereas flexible thin-film probes yield a marked accumulation of astrocytes and microglia and decrease of neurons for the same period. Quantitative analyses of 4- and 12-wk data showed that the signals for neurons, axons, astrocytes, and microglia are nearly the same from the mesh electronics surface to the baseline far from the probes, in contrast to flexible polymer probes, which show decreases in neuron and increases in astrocyte and microglia signals. Notably, images of sagittal brain slices containing nearly the entire mesh electronics probe showed that the tissue interface was uniform and neurons and neurofilaments penetrated through the mesh by 3 mo postimplantation. The minimal immune response and seamless interface with brain tissue postimplantation achieved by ultraflexible open mesh electronics probes provide substantial advantages and could enable a wide range of opportunities for in vivo chronic recording and modulation of brain activity in the future.

Trust in government and support for governmental regulation: the case of electronic health records.

PubMed

Herian, Mitchel N; Shank, Nancy C; Abdel-Monem, Tarik L

2014-12-01

This paper presents results from a public engagement effort in Nebraska, USA, which measured public opinions about governmental involvement in encouraging the use of electronic health records (EHRs). We examine the role of trust in government in contributing to public support for government involvement in the development of EHR technologies. We hypothesize that trust in government will lead to support for federal and state governmental encouragement of the use of EHRs among doctors and insurance companies. Further, because individual experiences with health-care professionals will reduce perceptions of risk, we expect that support for governmental involvement will be tempered by greater personal experience with the health-care industry. Examining a small survey of individuals on the issue, we find general support for both of our hypotheses. The findings suggest that trust in government does have a positive relationship with support for government involvement in the policy domain, but that the frequency of personal experiences with health-care providers reduces the extent to which the public supports governmental involvement in the development of EHR technology. This inquiry contributes to our understanding of public attitudes towards government involvement in EHRs in the United States specifically and contributes to social science examining links between trust in government and support for governmental activity in the emerging policy domain regarding electronic health records systems. © 2012 John Wiley & Sons Ltd.

[Integration of the nursing process in the electronic health record in an university hospital].

PubMed

Guadarrama-Ortega, D; Delgado-Sánchez, P; Martínez-Piedrola, M; López-Poves, E M; Acevedo-García, M; Noguera-Quijada, C; Camacho-Pastor, J L

To describe the process of implementation of Individualized Care Plan in the Electronic Health Record and its impact on the University Hospital Alcorcón Foundation. Working groups of staff nurses who analyzed activities usually performed to create a catalog of diagnoses, outcomes and interventions. A group of referents that refined the catalog to make it manageable was created. A training plan, nursing assessment forms and the Nursing Discharge Report were designed. In February 2016 the new methodology was implemented in inpatient units of adults. Between 74.86 and 88.18% of the patients underwent a care plan with the new methodology. Between 69.41 and 76.25% of patients are discharged with a Nursing Discharge Report accordance with regulations. An increase of 24.1% of patients with Nursing Discharge Report after implantation is observed (P=.000; RR: 1.46; 95% CI 1.36-1.56). A total of 116 nurses has been trained. In the study conditions, the use of nursing taxonomies has generated thinking skills and allowed nurses to issue judgments, ensure quality of care, and implementing interventions with a planned results. The nursing taxonomy and care plan in the Electronic Health Record have increased interprofessional communication to improve continuity of care through improved Nursing Discharge Report. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

From hospital information system components to the medical record and clinical guidelines & protocols.

PubMed

Veloso, M; Estevão, N; Ferreira, P; Rodrigues, R; Costa, C T; Barahona, P

1997-01-01

This paper introduces an ongoing project towards the development of a new generation HIS, aiming at the integration of clinical and administrative information within a common framework. Its design incorporates explicit knowledge about domain objects and professional activities to be processed by the system together with related knowledge management services and act management services. The paper presents the conceptual model of the proposed HIS architecture, that supports a rich and fully integrated patient data model, enabling the implementation of a dynamic electronic patient record tightly coupled with computerised guideline knowledge bases.

19 CFR 122.49d - Passenger Name Record (PNR) information.

Code of Federal Regulations, 2010 CFR

2010-04-01

...; DEPARTMENT OF THE TREASURY AIR COMMERCE REGULATIONS Aircraft Entry and Entry Documents; Electronic Manifest... request, provide Customs with electronic access to certain Passenger Name Record (PNR) information, as... access to requested PNR information, each air carrier must ensure that its electronic reservation...

Methods of defining hypertension in electronic medical records: validation against national survey data

PubMed Central

Peng, Mingkai; Chen, Guanmin; Kaplan, Gilaad G.; Lix, Lisa M.; Drummond, Neil; Lucyk, Kelsey; Garies, Stephanie; Lowerison, Mark; Weibe, Samuel; Quan, Hude

2016-01-01

Background Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification. Methods We included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011. Results Compared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records with a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE. Conclusions Different definitions should be used for different study purposes. The definition of ‘diagnosis code or two abnormal blood pressure records with a 2-year period’ could be used for hypertension surveillance in THIN. PMID:26547088

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine.

PubMed

Tai-Seale, Ming; Olson, Cliff W; Li, Jinnan; Chan, Albert S; Morikawa, Criss; Durbin, Meg; Wang, Wei; Luft, Harold S

2017-04-01

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts. Project HOPE—The People-to-People Health Foundation, Inc.

Tactile Feedback Display with Spatial and Temporal Resolutions

PubMed Central

Vishniakou, Siarhei; Lewis, Brian W.; Niu, Xiaofan; Kargar, Alireza; Sun, Ke; Kalajian, Michael; Park, Namseok; Yang, Muchuan; Jing, Yi; Brochu, Paul; Sun, Zhelin; Li, Chun; Nguyen, Truong; Pei, Qibing; Wang, Deli

2013-01-01

We report the electronic recording of the touch contact and pressure using an active matrix pressure sensor array made of transparent zinc oxide thin-film transistors and tactile feedback display using an array of diaphragm actuators made of an interpenetrating polymer elastomer network. Digital replay, editing and manipulation of the recorded touch events were demonstrated with both spatial and temporal resolutions. Analog reproduction of the force is also shown possible using the polymer actuators, despite of the high driving voltage. The ability to record, store, edit, and replay touch information adds an additional dimension to digital technologies and extends the capabilities of modern information exchange with the potential to revolutionize physical learning, social networking, e-commerce, robotics, gaming, medical and military applications. PMID:23982053

Tactile feedback display with spatial and temporal resolutions.

PubMed

Vishniakou, Siarhei; Lewis, Brian W; Niu, Xiaofan; Kargar, Alireza; Sun, Ke; Kalajian, Michael; Park, Namseok; Yang, Muchuan; Jing, Yi; Brochu, Paul; Sun, Zhelin; Li, Chun; Nguyen, Truong; Pei, Qibing; Wang, Deli

2013-01-01

We report the electronic recording of the touch contact and pressure using an active matrix pressure sensor array made of transparent zinc oxide thin-film transistors and tactile feedback display using an array of diaphragm actuators made of an interpenetrating polymer elastomer network. Digital replay, editing and manipulation of the recorded touch events were demonstrated with both spatial and temporal resolutions. Analog reproduction of the force is also shown possible using the polymer actuators, despite of the high driving voltage. The ability to record, store, edit, and replay touch information adds an additional dimension to digital technologies and extends the capabilities of modern information exchange with the potential to revolutionize physical learning, social networking, e-commerce, robotics, gaming, medical and military applications.

Tactile Feedback Display with Spatial and Temporal Resolutions

NASA Astrophysics Data System (ADS)

Vishniakou, Siarhei; Lewis, Brian W.; Niu, Xiaofan; Kargar, Alireza; Sun, Ke; Kalajian, Michael; Park, Namseok; Yang, Muchuan; Jing, Yi; Brochu, Paul; Sun, Zhelin; Li, Chun; Nguyen, Truong; Pei, Qibing; Wang, Deli

2013-08-01

We report the electronic recording of the touch contact and pressure using an active matrix pressure sensor array made of transparent zinc oxide thin-film transistors and tactile feedback display using an array of diaphragm actuators made of an interpenetrating polymer elastomer network. Digital replay, editing and manipulation of the recorded touch events were demonstrated with both spatial and temporal resolutions. Analog reproduction of the force is also shown possible using the polymer actuators, despite of the high driving voltage. The ability to record, store, edit, and replay touch information adds an additional dimension to digital technologies and extends the capabilities of modern information exchange with the potential to revolutionize physical learning, social networking, e-commerce, robotics, gaming, medical and military applications.

Very low frequency waves stimulated by an electron accelerator in the auroral ionosphere

NASA Technical Reports Server (NTRS)

Holtet, J. A.; Pran, B. K.; Egeland, A.; Grandal, B.; Jacobsen, T. A.; Maehlum, B. N.; Troim, J.

1981-01-01

The sounding rocket, Polar 5, carrying a 10 keV electron accelerator in a mother-daughter configuration and other diagnostic instruments, was launched into a slightly disturbed ionosphere with weak auroral activity on February 1, 1976 from Northern Norway to study VLF wave phenomena. The rocket trajectory crossed two auroral regions: one, between 86 and 111 s flight time, and a secondary region between 230 and 330 s. The daughter, carrying the accelerator, was separated axially from the mother in a forward direction at an altitude of 90 km. The VLF experiment, carried by the mother payload, recorded both electromagnetic and electrostatic waves. The receiving antenna was an electric dipole, 0.3 m tip-to-tip, oriented 90 degrees to the rocket spin axis. The onboard particle detector recorded increased electron fluxes in the two auroral regions. A double peaked structure was observed in the fluxes of 4-5 and 12-27 keV electrons within the northern auroral form. The number density of thermal plasma varied during the flight, with maximum density within the main auroral region. To the north of this aurora a slow, steady decrease in the density was observed, with no enhancement in the region of the second aurora.

Care team identification in the electronic health record: A critical first step for patient-centered communication.

PubMed

Dalal, Anuj K; Schnipper, Jeffrey L

2016-05-01

Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

24 CFR 982.158 - Program accounts and records.

Code of Federal Regulations, 2012 CFR

2012-04-01

... by HUD, including requirements governing computerized or electronic forms of record-keeping. The PHA... furnish to HUD accounts and other records, reports, documents and information, as required by HUD. For provisions on electronic transmission of required family data, see 24 CFR part 908. (c) HUD and the...

The Archival View of Technology: Resources for the Scholar of the Future.

ERIC Educational Resources Information Center

Zeidberg, David S.

1999-01-01

Archivists need to apply traditional principles of records management to electronic documents if these records are to survive for research by future scholars. Additionally, archivists must ensure that the electronic records preserved remain accessible as hardware and software change over time. (Author/AEF)

24 CFR 982.158 - Program accounts and records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... by HUD, including requirements governing computerized or electronic forms of record-keeping. The PHA... furnish to HUD accounts and other records, reports, documents and information, as required by HUD. For provisions on electronic transmission of required family data, see 24 CFR part 908. (c) HUD and the...

Automated Coding Software: Development and Use to Enhance Anti-Fraud Activities*

PubMed Central

Garvin, Jennifer H.; Watzlaf, Valerie; Moeini, Sohrab

2006-01-01

This descriptive research project identified characteristics of automated coding systems that have the potential to detect improper coding and to minimize improper or fraudulent coding practices in the setting of automated coding used with the electronic health record (EHR). Recommendations were also developed for software developers and users of coding products to maximize anti-fraud practices. PMID:17238546

Biofeedback With Implanted Blood-Pressure Device

NASA Technical Reports Server (NTRS)

Rischell, Robert E.

1988-01-01

Additional uses found for equipment described in "Implanted Blood-Pressure-Measuring Device" (GSC-13042). Implanted with device electronic circuitry that measures, interprets, and transmits data via inductive link through patient's skin to external receiver. Receiver includes audible alarm generator activated when patient's blood pressure exceeds predetermined threshold. Also included in receiver a blood-pressure display, recorder, or both, for use by patient or physician.

21st Century Intrusions into Learning. A Legal Memorandum: Quarterly Law Topics for School Leaders, Summer 2005

ERIC Educational Resources Information Center

Pickett, A. Dean; Thomas, Christopher

2005-01-01

Thirty to forty years ago educators had at most the challenge of tape recorders and players and transistor radios to confront as electronic distractions in the classroom. Then pagers were introduced and became associated with drug trafficking and gang activity. Not long after, the first cellular phones were introduced and, when they became…

A tutorial on activity-based costing of electronic health records.

PubMed

Federowicz, Marie H; Grossman, Mila N; Hayes, Bryant J; Riggs, Joseph

2010-01-01

As the American Recovery and Restoration Act of 2009 allocates $19 billion to health information technology, it will be useful for health care managers to project the true cost of implementing an electronic health record (EHR). This study presents a step-by-step guide for using activity-based costing (ABC) to estimate the cost of an EHR. ABC is a cost accounting method with a "top-down" approach for estimating the cost of a project or service within an organization. The total cost to implement an EHR includes obvious costs, such as licensing fees, and hidden costs, such as impact on productivity. Unlike other methods, ABC includes all of the organization's expenditures and is less likely to miss hidden costs. Although ABC is used considerably in manufacturing and other industries, it is a relatively new phenomenon in health care. ABC is a comprehensive approach that the health care field can use to analyze the cost-effectiveness of implementing EHRs. In this article, ABC is applied to a health clinic that recently implemented an EHR, and the clinic is found to be more productive after EHR implementation. This methodology can help health care administrators assess the impact of a stimulus investment on organizational performance.

Modeling a terminology-based electronic nursing record system: an object-oriented approach.

PubMed

Park, Hyeoun-Ae; Cho, InSook; Byeun, NamSoo

2007-10-01

The aim of this study was to present our perspectives on healthcare information analysis at a conceptual level and the lessons learned from our experience with the development of a terminology-based enterprise electronic nursing record system - which was one of components in an EMR system at a tertiary teaching hospital in Korea - using an object-oriented system analysis and design concept. To ensure a systematic approach and effective collaboration, the department of nursing constituted a system modeling team comprising a project manager, systems analysts, user representatives, an object-oriented methodology expert, and healthcare informaticists (including the authors). A rational unified process (RUP) and the Unified Modeling Language were used as a development process and for modeling notation, respectively. From the scenario and RUP approach, user requirements were formulated into use case sets and the sequence of activities in the scenario was depicted in an activity diagram. The structure of the system was presented in a class diagram. This approach allowed us to identify clearly the structural and behavioral states and important factors of a terminology-based ENR system (e.g., business concerns and system design concerns) according to the viewpoints of both domain and technical experts.

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.

Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

ERIC Educational Resources Information Center

Daniels, Cheryl Andrea

2013-01-01

With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

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.

Telemedicine

MedlinePlus

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

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...

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

PubMed

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

2008-01-01

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

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

PubMed Central

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

2008-01-01

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

Resonant two-photon ionization and mass-analyzed threshold ionization spectroscopy of p-vinylaniline

NASA Astrophysics Data System (ADS)

Tzeng, Sheng Yuan; Dong, Changwu; Tzeng, Wen Bih

2012-10-01

We report the vibronic and cation spectra of p-vinylaniline, which are recorded by using the resonant two-photon ionization and the mass-analyzed threshold ionization spectroscopic techniques. The band origin of the S1 ← S0 electronic transition appears at 31,490 ± 2 cm-1 and the adiabatic ionization energy is determined to be 59,203 ± 5 cm-1. Due to the nature of the substituent, the amino and vinyl groups lead to lower electronic excitation and ionization energies by a few thousand wave numbers. Most of the observed active modes result from the in-plane ring deformation and substituent-sensitive vibrations of this molecule in the electronically excited S1 and cationic ground D0 states. By comparing the frequencies of the observed active vibrations, one may conclude that the molecular geometry and the vibrational coordinates of these modes of the p-vinylaniline cation in the D0 state resemble those of the neutral species in the S1 state.

In situ Scanning Electron Microscopy of Silicon Anode Reactions in Lithium-Ion Batteries during Charge/Discharge Processes

PubMed Central

Chen, Chih-Yao; Sano, Teruki; Tsuda, Tetsuya; Ui, Koichi; Oshima, Yoshifumi; Yamagata, Masaki; Ishikawa, Masashi; Haruta, Masakazu; Doi, Takayuki; Inaba, Minoru; Kuwabata, Susumu

2016-01-01

A comprehensive understanding of the charge/discharge behaviour of high-capacity anode active materials, e.g., Si and Li, is essential for the design and development of next-generation high-performance Li-based batteries. Here, we demonstrate the in situ scanning electron microscopy (in situ SEM) of Si anodes in a configuration analogous to actual lithium-ion batteries (LIBs) with an ionic liquid (IL) that is expected to be a functional LIB electrolyte in the future. We discovered that variations in the morphology of Si active materials during charge/discharge processes is strongly dependent on their size and shape. Even the diffusion of atomic Li into Si materials can be visualized using a back-scattering electron imaging technique. The electrode reactions were successfully recorded as video clips. This in situ SEM technique can simultaneously provide useful data on, for example, morphological variations and elemental distributions, as well as electrochemical data. PMID:27782200

21 CFR 11.50 - Signature manifestations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Signature manifestations. 11.50 Section 11.50 Food... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.50 Signature manifestations. (a) Signed electronic...: (1) The printed name of the signer; (2) The date and time when the signature was executed; and (3...

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...

THE ELECTRONIC CLASSROOM--A GUIDE FOR PLANNING.

ERIC Educational Resources Information Center

CROSSMAN, DAVID M.

GUIDES TO AID ADMINISTRATORS IN THE SELECTION AND INSTALLATION OF ELECTRONIC CLASSROOMS ARE PRESENTED. ADVANTAGES OF AN ELECTRONIC CLASSROOM ARE THAT A VARIETY OF MATERIALS CAN BE USED, SPEECH PATTERNS CAN BE RECORDED FOR SUBSEQUENT EVALUATION, RECORDED LESSONS CAN BE USED AGAIN AND AGAIN, PROGRESS OF INDIVIDUAL STUDENTS CAN BE MONITORED WITHOUT…

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...

Simulated electronic heterodyne recording and processing of pulsed-laser holograms

NASA Technical Reports Server (NTRS)

Decker, A. J.

1979-01-01

The electronic recording of pulsed-laser holograms is proposed. The polarization sensitivity of each resolution element of the detector is controlled independently to add an arbitrary phase to the image waves. This method which can be used to simulate heterodyne recording and to process three-dimensional optical images, is based on a similar method for heterodyne recording and processing of continuous-wave holograms.

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.

40 CFR 98.97 - Records that must be retained.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) MANDATORY GREENHOUSE GAS REPORTING Electronics Manufacturing § 98.97 Records that must be... vapor deposition processes and for the aggregate of all other electronics manufacturing production...

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.

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