Benefits and drawbacks of electronic health record systems

Directory of Open Access Journals (Sweden)

Menachemi N

2011-05-01

Full Text Available Nir Menachemi¹, Taleah H Collum²¹Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA; ²Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: The Health Information Technology for Economic and Clinical Health (HITECH Act of 2009 that was signed into law as part of the "stimulus package" represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs. In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors, organizational outcomes (eg, financial and operational benefits, and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs. Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a “meaningful” way.Keywords: EHR, health information technology, HITECH, computerized order entry, health information exchange 

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

Science.gov (United States)

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.

Evolution of Medication Administration Workflow in Implementing Electronic Health Record System

Science.gov (United States)

Huang, Yuan-Han

2013-01-01

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

Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

Centers for Disease Control (CDC) Podcasts

In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.

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

Science.gov (United States)

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 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.

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

Science.gov (United States)

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.

Exploring Workarounds Related to Electronic Health Record System Usage: A Study Protocol

NARCIS (Netherlands)

Blijleven, Vincent; Koelemeijer, Kitty; Jaspers, Monique

2017-01-01

Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow that are unintentionally imposed by electronic health record (EHR) systems. Although workarounds may seem favorable at first sight, they are generally suboptimal and may

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

Science.gov (United States)

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.

75 FR 50987 - Privacy Act System of Records; National Animal Health Laboratory Network (NAHLN)

Science.gov (United States)

2010-08-18

...The U.S. Department of Agriculture (USDA) proposes to add a new Privacy Act system of records to its inventory of records systems subject to the Privacy Act of 1974, as amended, and invites public comment on this new records system. The system of records being proposed is the National Animal Health Laboratory Network. This notice is necessary to meet the requirements of the Privacy Act to publish in the Federal Register notice of the existence and character of record systems maintained by the agency. Although the Privacy Act requires only that the portion of the system that describes ``routine uses'' of the system be published for comment, USDA invites comment on all portions of this notice.

Towards the Adoption of Open Source and Open Access Electronic Health Record Systems

Directory of Open Access Journals (Sweden)

Ilias Maglogiannis

2012-01-01

Full Text Available As the Electronic Health Record (EHR systems constantly expand to support more clinical activities and their implementations in healthcare organizations become more widespread, several communities have been working intensively for several years to develop open access and open source EHR software, aiming at reducing the costs of EHR deployment and maintenance. In this paper, we describe and evaluate the most popular open source electronic medical records such as openEMR, openMRS and patientOS, providing their technical features and potentials. These systems are considered quite important due to their prevalence. The article presents the key features of each system and outlines the advantages and problems of Open Source Software (OSS Systems through a review of the literature, in order to demonstrate the possibility of their adoption in modern electronic healthcare systems. Also discussed are the future trends of OS EHRs in the context of the Personal Health Records and mobile computing paradigm.

Computerized health physics record system at a Canadian fabrication facility

International Nuclear Information System (INIS)

Thind, K.S.

1984-01-01

This poster session will describe the types of Health Physics data input into a Hewlett-Packard 3000 computer. The Health Physics data base at this facility includes the following: employee hours data, airborne uranium concentrations, external dosemetry (badge readings), internal dosemetry (bioassay) and environmental health physics (stack sample results) data. It will describe the types of outputs achievable in the form of various reports, such as: individual employee health physics report for a given period, a general health physics summary report for a given period, individual urinalysis report, local air concentration report and graphs. The use of this computerized health physics record system in the overall radiation protection program at this facility is discussed

Smart Card Based Integrated Electronic Health Record System For Clinical Practice

OpenAIRE

N. Anju Latha; B. Rama Murthy; U. Sunitha

2012-01-01

Smart cards are used in information technologies as portable integrated devices with data storage and data processing capabilities. As in other fields, smart card use in health systems became popular due to their increased capacity and performance. Smart cards are used as a Electronic Health Record (EHR) Their efficient use with easy and fast data access facilities leads to implementation particularly widespread in hospitals. In this paper, a smart card based Integrated Electronic health Reco...

Designing for Underserved Populations: Constraints and Requirements of Personal Health Record Systems

Centers for Disease Control (CDC) Podcasts

2009-02-11

In this podcast, Dr. Thomas Horan discusses how language, literacy, and access barriers can be overcome with electronic Personal Health Record (PHR) systems to improve health among the most vulnerable, isolated, and underserved populations.  Created: 2/11/2009 by Coordinating Center for Health Information Service (CCHIS), Healthy Healthcare Settings Goal Team, Office of Strategy and Innovation.   Date Released: 9/2/2009.

Fear of e-Health records implementation?

Science.gov (United States)

Laur, Audrey

2015-03-01

As our world is dominated by Information Communication and Technologies (ICT), governments of many leading countries have decided to implement ICT in their health systems. The first step is the digitalisation of medical records (e-Health Records or EHRs). In order to reduce concerns that health systems encountered, EHRs are supposed to prevent duplicated prescriptions and hospitalisations, ineffective transferability of medical records, lack of communication in clinical assessments, etc. They are also expected to improve the relationship between health providers and patients. At first sight, EHR seems to offer considerable potential for assisting health policies, enabling the development of new tools to facilitate coordination and cooperation among health professionals and promoting a new approach to sharing medical information. However, as discussed in this article, recent debates have shown that EHR presents pros and cons (technical, financial, social) that governments need to clarify urgently. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Evaluation of Electronic Health Record Implementation in Hospitals.

Science.gov (United States)

Tubaishat, Ahmad

2017-07-01

The effectiveness of electronic health records has not previously been widely evaluated. Thus, this national cross-sectional study was conducted to evaluate electronic health records, from the perspective of nurses, by examining how they use the records, their opinions on the quality of the systems, and their overall levels of satisfaction with electronic health records. The relationship between these constructs was measured, and its predictors were investigated. A random sample of Jordanian hospitals that used electronic health records was selected, and data were gathered using a self-administered questionnaire, based on the DeLone and McLean Information Systems Success model. In total, 1648 nurses from 17 different hospitals participated in the study. Results indicated that nurses were largely positive about the use and quality of the systems and were satisfied with electronic health records. Significant positive correlations were found between these constructs, and a number of demographical and situational factors were found to have an effect on nurses' perceptions. The study provides a systematic evaluation of different facets of electronic health records, which is fundamental for recognizing the motives and challenges for success and for further enhancing this success. The work proves that nurses favor the use of electronic health records and are satisfied with it and perceive its high quality, and the findings should therefore encourage their ongoing implementation.

Fine-Grained Access Control for Electronic Health Record Systems

Science.gov (United States)

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

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

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

Science.gov (United States)

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.

Electronic Health Records: PHR Opportunities for Public Health – Part 2

Centers for Disease Control (CDC) Podcasts

In this podcast, Dr. Ken Mandl discusses electronic health records and personally-controlled health records. Dr. Mandl leads the IndivoHealth personally-controlled health record project, the original reference model for the Microsoft, Google, and Dossia personal health records (PHRs or PCHRs). He has successfully used PHRs for immunization and influenza, leads efforts in real-time surveillance systems, and is currently adapting personal health records for longitudinal and genomic research. The lecture was given at CDC on June 19, 2009.

Electronic Health Records: PHR Opportunities for Public Health – Part 1

Centers for Disease Control (CDC) Podcasts

In this podcast, Dr. Ken Mandl discusses electronic health records and personally-controlled health records. Dr. Mandl leads the IndivoHealth personally-controlled health record project, the original reference model for the Microsoft, Google, and Dossia personal health records (PHRs or PCHRs). He has successfully used PHRs for immunization and influenza, leads efforts in real-time surveillance systems, and is currently adapting personal health records for longitudinal and genomic research. The lecture was given at CDC on June 19, 2009.

Use of Electronic Health Records and Administrative Data for Public Health Surveillance of Eye Health and Vision-Related Conditions

Science.gov (United States)

Elliott, Amanda; Davidson, Arthur; Lum, Flora; Chiang, Michael; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E.; Chou, Chiu-Fang

2014-01-01

Purpose To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Methods We describe three currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Results Each of the three sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Conclusions Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. PMID:23158225

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

Science.gov (United States)

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

2016-04-01

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

A student-centred electronic health record system for clinical education.

Science.gov (United States)

Elliott, Kristine; Judd, Terry; McColl, Geoff

2011-01-01

Electronic Health Record (EHR) systems are an increasingly important feature of the national healthcare system [1]. However, little research has investigated the impact this will have on medical students' learning. As part of an innovative technology platform for a new masters level program in medicine, we are developing a student-centred EHR system for clinical education. A prototype was trialed with medical students over several weeks during 2010. This paper reports on the findings of the trial, which had the overall aim of assisting our understanding of how trainee doctors might use an EHR system for learning and communication in a clinical setting. In primary care and hospital settings, EHR systems offer potential benefits to medical students' learning: Longitudinal tracking of clinical progress towards established learning objectives [2]; Capacity to search across a substantial body of records [3]; Integration with online medical databases [3]; Development of expertise in creating, accessing and managing high quality EHRs [4]. While concerns have been raised that EHR systems may alter the interaction between teachers and students [3], and may negatively influence physician-patient communication [6], there is general consensus that the EHR is changing the current practice environment and teaching practice needs to respond. Final year medical students on clinical placement at a large university teaching hospital were recruited for the trial. Following a four-week period of use, semi-structured interviews were conducted with 10 participants. Audio-recorded interviews were transcribed and data analysed for emerging themes. Study participants were also surveyed about the importance of EHR systems in general, their familiarity with them, and general perceptions of sharing patient records. Medical students in this pilot study identified a number of educational, practical and administrative advantages that the student-centred EHR system offered over their existing ad

The value of personal health record (PHR) systems.

Science.gov (United States)

Kaelber, David; Pan, Eric C

2008-11-06

Personal health records (PHRs) are a rapidly growing area of health information technology despite a lack of significant value-based assessment.Here we present an assessment of the potential value of PHR systems, looking at both costs and benefits.We examine provider-tethered, payer-tethered, and third-party PHRs, as well as idealized interoperable PHRs. An analytical model was developed that considered eight PHR application and infrastructure functions. Our analysis projects the initial and annual costs and annual benefits of PHRs to the entire US over the next 10 years.This PHR analysis shows that all forms of PHRs have initial net negative value. However, at the end of 10 years, steady state annual net value ranging from$13 billion to -$29 billion. Interoperable PHRs provide the most value, followed by third-party PHRs and payer-tethered PHRs also showing positive net value. Provider-tethered PHRs constantly demonstrating negative net value.

What are the effects of introducing electronic health recording systems? A systematic review including a scoping review. Prospero. Registration number CRD42018084313

DEFF Research Database (Denmark)

Jansbøl, Ulf Kåre; Rohde, Jeanett Friis; Jensen, Pia-Lis

2018-01-01

Electronic health recording systems have been in use for more than 10 in some countries, regions and hospitals. More countries, regions and hospitals introduce and use electronic health recording systems. To our knowledge, it is unknown what research has been done on the clinical effects, patients...... satisfaction and health professionals satisfaction relating to electronic health recording systems. Furthermore, it is unknown if there exist sufficient research to do systematic reviews on clinical effects, patients satisfaction and health professionals satisfaction relating to electronic health recording...... systems. Furthermore, it is unknown, what the result of the research shows. Such knowledge is important since it points out what research needs to be done. Furthermore, it informs decision making on using or not using electronic health recording systems. Finally, it is important to know how satisfied...

Communication and the electronic health record training: a comparison of three healthcare systems.

Science.gov (United States)

Lynott, Michelle H; Kooienga, Sarah A; Stewart, Valerie T

2012-01-01

The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient-provider communication. Many studies have focused on communication in the examination room. Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians. One researcher participated in and observed three health systems' EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient-provider communication. Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR. The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes.

Electronic health records to facilitate clinical research.

Science.gov (United States)

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.

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

Science.gov (United States)

Monroe, C Douglas; Chin, Karen Y

2013-05-01

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

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

Science.gov (United States)

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

Health Data Recording, Reporting and Utilization Practices Among ...

African Journals Online (AJOL)

Health Data Recording, Reporting and Utilization Practices Among Primary Health Care Workers in Enugu State, South Eastern Nigeria. ... of PHC workers used notepads, 52.3% used notebooks while only 47.7% used health management information system (HMIS) forms to record data. ... AJOL African Journals Online.

Electronic Health Records: PHR Opportunities for Public Health – Part 2

Centers for Disease Control (CDC) Podcasts

2009-09-10

In this podcast, Dr. Ken Mandl discusses electronic health records and personally-controlled health records. Dr. Mandl leads the IndivoHealth personally-controlled health record project, the original reference model for the Microsoft, Google, and Dossia personal health records (PHRs or PCHRs). He has successfully used PHRs for immunization and influenza, leads efforts in real-time surveillance systems, and is currently adapting personal health records for longitudinal and genomic research. The lecture was given at CDC on June 19, 2009.  Created: 9/10/2009 by Coordinating Center for Health Information Service (CCHIS), Healthy Healthcare Settings Goal Team, Office of Strategy and Innovation.   Date Released: 6/3/2010.

Electronic Health Records: PHR Opportunities for Public Health – Part 1

Centers for Disease Control (CDC) Podcasts

2009-09-10

In this podcast, Dr. Ken Mandl discusses electronic health records and personally-controlled health records. Dr. Mandl leads the IndivoHealth personally-controlled health record project, the original reference model for the Microsoft, Google, and Dossia personal health records (PHRs or PCHRs). He has successfully used PHRs for immunization and influenza, leads efforts in real-time surveillance systems, and is currently adapting personal health records for longitudinal and genomic research. The lecture was given at CDC on June 19, 2009.  Created: 9/10/2009 by Coordinating Center for Health Information Service (CCHIS), Healthy Healthcare Settings Goal Team, Office of Strategy and Innovation.   Date Released: 6/3/2010.

77 FR 65939 - Privacy Act of 1974; System of Records

Science.gov (United States)

2012-10-31

...) is amending the system of records currently entitled ``Veterans Health Information Systems and... Health Information Systems and Technology Architecture (VistA) Records-VA ROUTINE USES OF RECORDS... DEPARTMENT OF VETERANS AFFAIRS Privacy Act of 1974; System of Records AGENCY: Department of...

Nurses' Experiences of an Initial and Reimplemented Electronic Health Record Use.

Science.gov (United States)

Chang, Chi-Ping; Lee, Ting-Ting; Liu, Chia-Hui; Mills, Mary Etta

2016-04-01

The electronic health record is a key component of healthcare information systems. Currently, numerous hospitals have adopted electronic health records to replace paper-based records to document care processes and improve care quality. Integrating healthcare information system into traditional nursing daily operations requires time and effort for nurses to become familiarized with this new technology. In the stages of electronic health record implementation, smooth adoption can streamline clinical nursing activities. In order to explore the adoption process, a descriptive qualitative study design and focus group interviews were conducted 3 months after and 2 years after electronic health record system implementation (system aborted 1 year in between) in one hospital located in southern Taiwan. Content analysis was performed to analyze the interview data, and six main themes were derived, in the first stage: (1) liability, work stress, and anticipation for electronic health record; (2) slow network speed, user-unfriendly design for learning process; (3) insufficient information technology/organization support; on the second stage: (4) getting used to electronic health record and further system requirements, (5) benefits of electronic health record in time saving and documentation, (6) unrealistic information technology competence expectation and future use. It concluded that user-friendly design and support by informatics technology and manpower backup would facilitate this adoption process as well.

Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study.

Science.gov (United States)

Woods, Susan S; Schwartz, Erin; Tuepker, Anais; Press, Nancy A; Nazi, Kim M; Turvey, Carolyn L; Nichol, W Paul

2013-03-27

Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. A qualitative study with purposeful sampling sought to examine patients' views and experiences with reading their health records, including their clinical notes, online. Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared

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

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

2016-01-01

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

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

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... the National Technical Information Service NCHS Use and Characteristics of Electronic Health Record Systems Among Office-based ... physicians that collects information on physician and practice characteristics, including the adoption and use of EHR systems. ...

Communication and the electronic health record training: a comparison of three healthcare systems

Directory of Open Access Journals (Sweden)

Michelle H Lynott

2013-12-01

Full Text Available Background The electronic health record (EHR used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient–provider communication. Many studies have focused on communication in the examination room.Purpose Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians. The purpose of this study was to explore various health record training programmes for clinicians.Methods One researcher participated in and observed three health systems’ EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient–provider communication.Results Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR.Conclusions The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes.

77 FR 65564 - Privacy Act of 1974; System of Records

Science.gov (United States)

2012-10-29

... Medical, Health and Billing Records system is the authoritative source of patients' IHS medical records... authoritative records, nor are they considered part of the IHS Medical, Health and Billing Records system of...

Electronic health records access during a disaster.

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Morchel, Herman; Raheem, Murad; Stevens, Lee

2014-01-01

As has been demonstrated previously, medical care providers that employ an electronic health records (EHR) system provide more appropriate, cost effective care. Those providers are also better positioned than those who rely on paper records to recover if their facility is damaged as a result of severe storms, fires, or other events. The events surrounding Superstorm Sandy in 2012 made it apparent that, with relatively little additional effort and investment, health care providers with EHR systems may be able to use those systems for patient care purposes even during disasters that result in damage to buildings and facilities, widespread power outages, or both.

78 FR 37775 - Privacy Act Systems of Records; Phytosanitary Certificate Issuance and Tracking System

Science.gov (United States)

2013-06-24

... DEPARTMENT OF AGRICULTURE Office of the Secretary [Docket No. APHIS-2012-0104] Privacy Act Systems of Records; Phytosanitary Certificate Issuance and Tracking System AGENCY: Animal and Plant Health... Health Inspection Service proposes to add a system of records to its inventory of records systems subject...

Electronic Health Record Meets Digital Library

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Humphreys, Betsy L.

2000-01-01

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

Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States.

Science.gov (United States)

Elliott, Amanda F; Davidson, Arthur; Lum, Flora; Chiang, Michael F; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E; Chou, Chiu-Fang

2012-12-01

To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Perspective, comparing systems. We describe 3 currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Each of the 3 sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. Copyright © 2012 Elsevier Inc. All rights reserved.

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

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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…

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

Directory of Open Access Journals (Sweden)

Martínez-García Ana I

2010-10-01

Full Text Available Abstract 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

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

Science.gov (United States)

Castillo, Víctor H; Martínez-García, Ana I; Pulido, J R G

2010-10-15

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. 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. 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

Mandatory Use of Electronic Health Records: Overcoming Physician Resistance

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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…

Sharing electronic health records: the patient view

Directory of Open Access Journals (Sweden)

John Powell

2006-03-01

Full Text Available The introduction of a national electronic health record system to the National Health Service (NHS has raised concerns about issues of data accuracy, security and confidentiality. The primary aim of this project was to identify the extent to which primary care patients will allow their local electronic record data to be shared on a national database. The secondary aim was to identify the extent of inaccuracies in the existing primary care records, which will be used to populate the new national Spine. Fifty consecutive attenders to one general practitioner were given a paper printout of their full primary care electronic health record. Participants were asked to highlight information which they would not want to be shared on the national electronic database of records, and information which they considered to be incorrect. There was a 62% response rate (31/50. Five of the 31 patients (16% identified information that they would not want to be shared on the national record system. The items they identified related almost entirely to matters of pregnancy, contraception, sexual health and mental health. Ten respondents (32% identified incorrect information in their records (some of these turned out to be correct on further investigation. The findings in relation to data sharing fit with the commonly held assumption that matters related to sensitive or embarrassing issues, which may affect how the patient will be treated by other individuals or institutions, are most likely to be censored by patients. Previous work on this has tended to ask hypothetical questions concerning data sharing rather than examine a real situation. A larger study of representative samples of patients in both primary and secondary care settings is needed to further investigate issues of data sharing and consent.

The E-health Literacy Demands of Australia's My Health Record: A Heuristic Evaluation of Usability.

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Walsh, Louisa; Hemsley, Bronwyn; Allan, Meredith; Adams, Natalie; Balandin, Susan; Georgiou, Andrew; Higgins, Isabel; McCarthy, Shaun; Hill, Sophie

2017-01-01

My Health Record is Australia's electronic personal health record system, which was introduced in July 2012. As of August 2017, approximately 21 percent of Australia's total population was registered to use My Health Record. Internationally, usability issues have been shown to negatively influence the uptake and use of electronic health record systems, and this scenario may particularly affect people who have low e-health literacy. It is likely that usability issues are negatively affecting the uptake and use of My Health Record in Australia. To identify potential e-health literacy-related usability issues within My Health Record through a heuristic evaluation method. Between September 14 and October 12, 2016, three of the authors conducted a heuristic evaluation of the two consumer-facing components of My Health Record-the information website and the electronic health record itself. These two components were evaluated against two sets of heuristics-the Health Literacy Online checklist and the Monkman Heuristics. The Health Literacy Online checklist and Monkman Heuristics are evidence-based checklists of web design elements with a focus on design for audiences with low health literacy. During this heuristic evaluation, the investigators individually navigated through the consumer-facing components of My Health Record, recording instances where the My Health Record did not conform to the checklist criteria. After the individual evaluations were completed, the investigators conferred and aggregated their results. From this process, a list of usability violations was constructed. When evaluated against the Health Literacy Online Checklist, the information website demonstrated violations in 12 of 35 criteria, and the electronic health record demonstrated violations in 16 of 35 criteria. When evaluated against the Monkman Heuristics, the information website demonstrated violations in 7 of 11 criteria, and the electronic health record demonstrated violations in 9 of 11

Security Techniques for the Electronic Health Records.

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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.

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

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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.

Ethical questions must be considered for electronic health records.

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

2012-09-01

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

Personal health records

DEFF Research Database (Denmark)

Kensing, Finn

2012-01-01

The paper addresses the complex interplay between patients, healthcare professionals, and technology in relation to the treatment of chronic patients. It reflects on an ongoing interdisciplinary action research project striving to design and implement IT support for communication and collaboration...... in the distributed heterogeneous network of chronic patients and the healthcare professionals that take care of them. An interactive personal health record (PHR) has been designed as part of the project. As such it is part of a trend to find ways to include patients in their own care process. This has been motivated...... by expected health benefits for the patients as well as promises to lead to reduced costs for a burdened healthcare system....

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

Science.gov (United States)

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

2018-02-01

Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital's current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records

Leveraging the Value of Human Relationships to Improve Health Outcomes. Lessons learned from the OpenMRS Electronic Health Record System.

Science.gov (United States)

Kasthurirathne, Suranga N; Mamlin, Burke W; Cullen, Theresa

2017-02-01

Despite significant awareness on the value of leveraging patient relationships across the healthcare continuum, there is no research on the potential of using Electronic Health Record (EHR) systems to store structured patient relationship data, or its impact on enabling better healthcare. We sought to identify which EHR systems supported effective patient relationship data collection, and for systems that do, what types of relationship data is collected, how this data is used, and the perceived value of doing so. We performed a literature search to identify EHR systems that supported patient relationship data collection. Based on our results, we defined attributes of an effective patient relationship model. The Open Medical Record System (OpenMRS), an open source medical record platform for underserved settings met our eligibility criteria for effective patient relationship collection. We performed a survey to understand how the OpenMRS patient relationship model was used, and how it brought value to implementers. The OpenMRS patient relationship model has won widespread adoption across many implementations and is perceived to be valuable in enabling better health care delivery. Patient relationship information is widely used for community health programs and enabling chronic care. Additionally, many OpenMRS implementers were using this feature to collect custom relationship types for implementation specific needs. We believe that flexible patient relationship data collection is critical for better healthcare, and can inform community care and chronic care initiatives across the world. Additionally, patient relationship data could also be leveraged for many other initiatives such as patient centric care and in the field of precision medicine.

System requirements for a computerised patient record information system at a busy primary health care clinic

Directory of Open Access Journals (Sweden)

PJ Blignaut

2001-09-01

Full Text Available A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

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

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Gomillion, David L.

2017-01-01

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

Decision Support System for Medical Care Quality Assessment Based on Health Records Analysis in Russia.

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Taranik, Maksim; Kopanitsa, Georgy

2017-01-01

The paper presents developed decision system, oriented for healthcare providers. The system allows healthcare providers to detect and decrease nonconformities in health records and forecast the sum of insurance payments taking into account nonconformities. The components are ISO13606, fuzzy logic and case-based reasoning concept. The result of system implementation allowed to 10% increase insurance payments for healthcare provider.

The use of electronic health records in Spanish hospitals.

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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.

Consumer Adoption of Personal Health Record Systems: A Self-Determination Theory Perspective.

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Assadi, Vahid; Hassanein, Khaled

2017-07-27

Personal Health Records (PHR) systems provide individuals with access and control over their health information and consequently can support individuals in becoming active participants, rather than passive recipients, in their own care process. In spite of numerous benefits suggested for consumers' utilizing PHR systems, research has shown that such systems are not yet widely adopted or well known to consumers. Bearing in mind the potential benefits of PHRs to consumers and their potential interest in these systems-and that similar to any other type of information system, adoption is a prerequisite for realizing the potential benefits of PHR systems-research is needed to understand how to enhance the adoption rates for PHR systems. This research seeks to understand how individuals' intentions to adopt PHR systems are affected by their self-determination in managing their own health-the extent of their ability to take an active role in managing their own health. As such, this research aims to develop and empirically validate a theoretical model that explains PHR systems adoption by the general public through the integration of theories from the information systems and psychology literatures. This research employs a cross-sectional survey method targeted at the Canadian general public without any prior experience in using PHR systems. A partial least squares approach to structural equation modeling was used to validate the proposed research model of this study (N=159). Individuals with higher levels of ability to manage their own health (self-determination) are more likely to adopt PHR systems since they have more positive perceptions regarding the use of such systems. Further, such self-determination is fueled by autonomy support from consumers' physicians as well as the consumers' personality trait of autonomy orientation. This study advances our theoretical understanding of PHR systems adoption. It also contributes to practice by providing insightful implications

Development and implementation of a 'Mental Health Finder' software tool within an electronic medical record system.

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Swan, D; Hannigan, A; Higgins, S; McDonnell, R; Meagher, D; Cullen, W

2017-02-01

In Ireland, as in many other healthcare systems, mental health service provision is being reconfigured with a move toward more care in the community, and particularly primary care. Recording and surveillance systems for mental health information and activities in primary care are needed for service planning and quality improvement. We describe the development and initial implementation of a software tool ('mental health finder') within a widely used primary care electronic medical record system (EMR) in Ireland to enable large-scale data collection on the epidemiology and management of mental health and substance use problems among patients attending general practice. In collaboration with the Irish Primary Care Research Network (IPCRN), we developed the 'Mental Health Finder' as a software plug-in to a commonly used primary care EMR system to facilitate data collection on mental health diagnoses and pharmacological treatments among patients. The finder searches for and identifies patients based on diagnostic coding and/or prescribed medicines. It was initially implemented among a convenience sample of six GP practices. Prevalence of mental health and substance use problems across the six practices, as identified by the finder, was 9.4% (range 6.9-12.7%). 61.9% of identified patients were female; 25.8% were private patients. One-third (33.4%) of identified patients were prescribed more than one class of psychotropic medication. Of the patients identified by the finder, 89.9% were identifiable via prescribing data, 23.7% via diagnostic coding. The finder is a feasible and promising methodology for large-scale data collection on mental health problems in primary care.

Exploiting Multimodal Biometrics in E-Privacy Scheme for Electronic Health Records

OpenAIRE

Omotosho, Adebayo; Adegbola, Omotanwa; Adelakin, Barakat; Adelakun, Adeyemi; Emuoyibofarhe, Justice

2015-01-01

Existing approaches to protect the privacy of Electronic Health Records are either insufficient for existing medical laws or they are too restrictive in their usage. For example, smart card-based encryption systems require the patient to be always present to authorize access to medical records. Questionnaires were administered by 50 medical practitioners to identify and categorize different Electronic Health Records attributes. The system was implemented using multi biometrics of patients to ...

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

Science.gov (United States)

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.

Aspects of privacy for electronic health records.

Science.gov (United States)

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

2011-02-01

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

Quality and integration of public health information systems: A systematic review focused on immunization and vital records systems.

Science.gov (United States)

Vest, Joshua R; Kirk, Hilary M; Issel, L Michele

2012-01-01

Public health professionals rely on quantitative data for the daily practice of public health as well as organizational decision making and planning. However, several factors work against effective data sharing among public health agencies in the US. This review characterizes the reported barriers and enablers of effective use of public health IS from an informatics perspective. A systematic review of the English language literature for 2005 to 2011 followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. The review focused on immunization information systems (IIS) and vital records information systems (VRIS). Systems were described according to the structural aspects of IS integration and data quality. Articles describing IIS documented issues pertaining to the distribution of the system, the autonomy of the data providers, the heterogeneous nature of information sharing as well as the quality of the data. Articles describing VRIS were focused much more heavily on data quality, particularly whether or not the data were free from errors. For state and local practitioners to effectively utilize data, public health IS will have to overcome the challenges posed by a large number of autonomous data providers utilizing a variety of technologies.

Julius – a template based supplementary electronic health record system

Directory of Open Access Journals (Sweden)

Klein Gunnar O

2007-05-01

Full Text Available Abstract Background EHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. Our objective was to provide a more flexible solution enabling the clinicians to define which data to be recorded and shared for both routine documentation and clinical studies. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data. Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems. Methods We have designed and developed a template based system (called Julius that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely web-based, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database. Results The Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems. Conclusion The approach of the template system in combination with various local EHR

Electronic Health Records in the Cloud: Improving Primary Health Care Delivery in South Africa.

Science.gov (United States)

Cilliers, Liezel; Wright, Graham

2017-01-01

In South Africa, the recording of health data is done manually in a paper-based file, while attempts to digitize healthcare records have had limited success. In many countries, Electronic Health Records (EHRs) has developed in silos, with little or no integration between different operational systems. Literature has provided evidence that the cloud can be used to 'leapfrog' some of these implementation issues, but the adoption of this technology in the public health care sector has been very limited. This paper aims to identify the major reasons why the cloud has not been used to implement EHRs for the South African public health care system, and to provide recommendations of how to overcome these challenges. From the literature, it is clear that there are technology, environmental and organisational challenges affecting the implementation of EHRs in the cloud. Four recommendations are provided that can be used by the National Department of Health to implement EHRs making use of the cloud.

Personal health records: retrieving contextual information with Google Custom Search.

Science.gov (United States)

Ahsan, Mahmud; Seldon, H Lee; Sayeed, Shohel

2012-01-01

Ubiquitous personal health records, which can accompany a person everywhere, are a necessary requirement for ubiquitous healthcare. Contextual information related to health events is important for the diagnosis and treatment of disease and for the maintenance of good health, yet it is seldom recorded in a health record. We describe a dual cellphone-and-Web-based personal health record system which can include 'external' contextual information. Much contextual information is available on the Internet and we can use ontologies to help identify relevant sites and information. But a search engine is required to retrieve information from the Web and developing a customized search engine is beyond our scope, so we can use Google Custom Search API Web service to get contextual data. In this paper we describe a framework which combines a health-and-environment 'knowledge base' or ontology with the Google Custom Search API to retrieve relevant contextual information related to entries in a ubiquitous personal health record.

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

Science.gov (United States)

Aquino, Cesar A.

2014-01-01

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

Privacy Act of 1974; system of records--PHS. Waiver of advance notice period for a new system of records.

Science.gov (United States)

1983-08-30

FR Doc. 83-18581, appearing at page 31738 in the issue of Monday, July 11, 1983, provided notification of a new system of records proposed by the Health Resources and Services Administration (HRSA). That system is 09-15-0045, "Health Resources and Services Administration Loan Repayment/Debt Management Records System, HHS/HRSA/OA." The document stated that the Public Health Service had requested that the Office of Management and Budget (OMB) grant a waiver of the usual requirement that a system of records not be put into effect until 60 days after the report is sent to OMB and the Congress OMB granted the requested waiver on August 3, 1983. Accordingly, the new system of records, 09-15-0045, became effective upon the date of the waiver except for the routine uses established for the system. They became effective August 11, 1983, following the public comment period. However, in response to a comment received from the responsible oversight committee of the U.S. House of Representatives, we are adding a routine use to permit disclosure of information from these records to the General Accounting Office (GAO) and OMB for auditing financial obligations. We are also modifying one of the existing routine uses. PHS invites interested parties to submit comments on the proposed new routine use on or before September 29, 1983. In accordance with the Debt Collection Act of 1982 (Pub. L. 97-365), we are also adding the "special disclosure" statement. This statement does not require a public comment period.

Physicians perceptions of an educational support system integrated into an electronic health record.

Science.gov (United States)

Borbolla, Damian; Gorman, Paul; Del Fiol, Guilherme; Mohan, Vishnu; Hersh, William; Otero, Carlos; Luna, Daniel; Gonzalez Bernaldo De Quiros, Fernan

2013-01-01

The purpose of this study is to determine the perceptions by physicians of an educational system integrated into an electronic health record (EHR). Traditional approaches to continuous medical education (CME) have not shown improvement in patient health care outcomes. Hospital Italiano de Buenos Aires (HIBA) has implemented a system that embeds information pearls into the EHR, providing learning opportunities that are integrated into the patient care process. This study explores the acceptability and general perceptions of the system by physicians when they are in the consulting room. We interviewed 12 physicians after one or two weeks of using this CME system and we performed a thematic analysis of these interviews. The themes that emerged were use and ease of use of the system; value physicians gave to the system; educational impact on physicians; respect for the individual learning styles; content available in the system; and barriers that were present or absent for using the CME system. We found that the integrated CME system developed at HIBA was well accepted and perceived as useful and easy to use. Future work will involve modifications to the system interface, expansion of the content offered and further evaluation.

Modelling and implementing electronic health records in Denmark

DEFF Research Database (Denmark)

Bernstein, Knut; Rasmussen, Morten Bruun; Vingtoft, Søren

2003-01-01

The Danish Health IT strategy points out that integration between electronic health records (EHR) systems has a high priority. This paper reporst reports new tendencies in modelling and integration platforms globally and how this is reflected in the natinal development....

Measuring use of electronic health record functionality using system audit information.

Science.gov (United States)

Bowes, Watson A

2010-01-01

Meaningful and efficient methods for measuring Electronic Health Record (EHR) adoption and functional usage patterns have recently become important for hospitals, clinics, and health care networks in the United State due to recent government initiatives to increase EHR use. To date, surveys have been the method of choice to measure EHR adoption. This paper describes another method for measuring EHR adoption which capitalizes on audit logs, which are often common components of modern EHRs. An Audit Data Mart is described which identified EHR functionality within 836 Departments, within 22 Hospitals and 170 clinics at Intermountain Healthcare, a large integrated delivery system. The Audit Data Mart successfully identified important and differing EHR functional usage patterns. These patterns were useful in strategic planning, tracking EHR implementations, and will likely be utilized to assist in documentation of "Meaningful Use" of EHR functionality.

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

Science.gov (United States)

Marceglia, S; Fontelo, P; Rossi, E; Ackerman, M J

2015-01-01

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

Impact of an Electronic Health Record-Integrated Personal Health Record on Patient Participation in Health Care: Development and Randomized Controlled Trial of MyHealthKeeper.

Science.gov (United States)

Ryu, Borim; Kim, Nari; Heo, Eunyoung; Yoo, Sooyoung; Lee, Keehyuck; Hwang, Hee; Kim, Jeong-Whun; Kim, Yoojung; Lee, Joongseek; Jung, Se Young

2017-12-07

Personal health record (PHR)-based health care management systems can improve patient engagement and data-driven medical diagnosis in a clinical setting. The purpose of this study was (1) to demonstrate the development of an electronic health record (EHR)-tethered PHR app named MyHealthKeeper, which can retrieve data from a wearable device and deliver these data to a hospital EHR system, and (2) to study the effectiveness of a PHR data-driven clinical intervention with clinical trial results. To improve the conventional EHR-tethered PHR, we ascertained clinicians' unmet needs regarding PHR functionality and the data frequently used in the field through a cocreation workshop. We incorporated the requirements into the system design and architecture of the MyHealthKeeper PHR module. We constructed the app and validated the effectiveness of the PHR module by conducting a 4-week clinical trial. We used a commercially available activity tracker (Misfit) to collect individual physical activity data, and developed the MyHealthKeeper mobile phone app to record participants' patterns of daily food intake and activity logs. We randomly assigned 80 participants to either the PHR-based intervention group (n=51) or the control group (n=29). All of the study participants completed a paper-based survey, a laboratory test, a physical examination, and an opinion interview. During the 4-week study period, we collected health-related mobile data, and study participants visited the outpatient clinic twice and received PHR-based clinical diagnosis and recommendations. A total of 68 participants (44 in the intervention group and 24 in the control group) completed the study. The PHR intervention group showed significantly higher weight loss than the control group (mean 1.4 kg, 95% CI 0.9-1.9; Phealth tracker system and its potential to improve patient clinical profiles. ClinicalTrials.gov NCT03200119; https://clinicaltrials.gov/ct2/show/NCT03200119 (Archived by WebCite at http

Confidentiality Protection of Digital Health Records in Cloud Computing.

Science.gov (United States)

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

2016-05-01

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

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

Science.gov (United States)

Wojcik, Lauren

2015-01-01

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

77 FR 15360 - Privacy Act of 1974; Systems of Records

Science.gov (United States)

2012-03-15

... a System of Records. SUMMARY: The National Security Agency (NSA) is amending a system of records... Officer, Department of Defense. GNSA 06 System Name: NSA/CSS Health, Medical and Safety Files (February 10... of the NSA/CSS compilation of system of records notices apply to this system.'' * * * * * Storage...

Regional economic development programs related to the registration systems for the health records of radiation workers

International Nuclear Information System (INIS)

Nakagawa, Haruo; Kanda, Keiji

2000-01-01

The two policies, 'Promotion of Health Care for Elderly Person' and Completion of Health Care System' are important for regional economic development. If we apply the Health Records Registration Systems for Radiation Workers to the Regional Health Care System, we can get a more effective plan for regional economic development. In Japan, most of the electric power companies depend on radiation works to the external labor. As the chance of employment usually depends on the time and the period of outage of nuclear power stations, the employment of radiation works lacks its stability. From the analysis on the mobility of radiation workers, we can see the stability of employment increases in proportion to the number of reactors. This paper proposes the need for such a registration system to be granted under three laws governing special accounts for power supply municipalities and to set up the system within regional medical information systems. It also proposes the founding of an Overall Health Insurance Cooperative, managed by contractors safety union in the municipalities as soon as the condition of founding, 3, 000 people, is satisfied. (author)

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

Science.gov (United States)

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

2009-01-01

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

Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions.

Science.gov (United States)

Bouayad, Lina; Ialynytchev, Anna; Padmanabhan, Balaji

2017-11-15

A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice. We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content. We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation. Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR

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

Science.gov (United States)

Zhang, Rui

2013-01-01

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

Are personal health records safe? A review of free web-accessible personal health record privacy policies.

Science.gov (United States)

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

2012-08-23

Several obstacles prevent the adoption and use of personal health record (PHR) systems, including users' concerns regarding the privacy and security of their personal health information. To analyze the privacy and security characteristics of PHR privacy policies. It is hoped that identification of the strengths and weaknesses of the PHR systems will be useful for PHR users, health care professionals, decision makers, and designers. We conducted a systematic review using the principal databases related to health and computer science to discover the Web-based and free PHR systems mentioned in published articles. The privacy policy of each PHR system selected was reviewed to extract its main privacy and security characteristics. The search of databases and the myPHR website provided a total of 52 PHR systems, of which 24 met our inclusion criteria. Of these, 17 (71%) allowed users to manage their data and to control access to their health care information. Only 9 (38%) PHR systems permitted users to check who had accessed their data. The majority of PHR systems used information related to the users' accesses to monitor and analyze system use, 12 (50%) of them aggregated user information to publish trends, and 20 (83%) used diverse types of security measures. Finally, 15 (63%) PHR systems were based on regulations or principles such as the US Health Insurance Portability and Accountability Act (HIPAA) and the Health on the Net Foundation Code of Conduct (HONcode). Most privacy policies of PHR systems do not provide an in-depth description of the security measures that they use. Moreover, compliance with standards and regulations in PHR systems is still low.

A consumer health record for supporting the patient-centered management of chronic diseases

NARCIS (Netherlands)

de Clercq, Paul A.; Hasman, Arie; Wolffenbuttel, Bruce H. R.

2003-01-01

OBJECTIVES: To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. METHODS: A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

A consumer health record for supporting the patient-centered management of chronic diseases

NARCIS (Netherlands)

Clercq, de P.A.; Hasman, A.; Wolffenbuttel, B.H.R.

2003-01-01

Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

A consumer health record for supporting the patient-centered management of chronic diseases

NARCIS (Netherlands)

De Clercq, Paul A; Hasman, Arie; Wolffenbuttel, Bruce H R

Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

Operating Room Delays: Meaningful Use in Electronic Health Record.

Science.gov (United States)

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.

75 FR 52513 - Privacy Act of 1974; System of Records

Science.gov (United States)

2010-08-26

... practices data, and employee health hazard educational data. Records include the name, Social Security... system of records notice. Note 2: Personal identity, diagnosis, prognosis of any patient maintained in... Records in the System: Storage: Paper records and electronic storage media. Retrievability: By individual...

Attitude Towards Health Information Privacy and Electronic Health Records Among Urban Sri Lankan Adults.

Science.gov (United States)

Tissera, Shaluni R; Silva, S N

2016-01-01

Sri Lanka is planning to move towards an Electronic Health Record (EHR) system. This research argues that the public preparedness should be considered in order to implement a functioning and an effective EHR system in a country. When asked about how concerned the participants were about the security of their health records, 40.5% stated they were concerned and 38.8% were very concerned. They were asked to rate the 'level of trust' they have on health institutes in Sri Lanka on a scale from 1 to 10 (1 lowest level of trust and 10 highest), 66.1% rated at level 5 or less.

The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings.

Science.gov (United States)

Nazi, Kim M

2013-04-04

Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals' accounts and analysis of organizational

78 FR 60245 - Privacy Act Systems of Records; LabWare Laboratory Information Management System

Science.gov (United States)

2013-10-01

... of Records; LabWare Laboratory Information Management System AGENCY: Animal and Plant Health... system of records, entitled LabWare Laboratory Information Management System (LabWare LIMS), to maintain... Affairs, OMB. Thomas J. Vilsack, Secretary. SYSTEM NAME: LabWare Laboratory Information Management System...

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

Science.gov (United States)

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.

A shared electronic health record: lessons from the coalface.

Science.gov (United States)

Silvester, Brett V; Carr, Simon J

2009-06-01

A shared electronic health record system has been successfully implemented in Australia by a Division of General Practice in northern Brisbane. The system grew out of coordinated care trials that showed the critical need to share summary patient information, particularly for patients with complex conditions who require the services of a wide range of multisector, multidisciplinary health care professionals. As at 30 April 2008, connected users of the system included 239 GPs from 66 general practices, two major public hospitals, three large private hospitals, 11 allied health and community-based provider organisations and 1108 registered patients. Access data showed a patient's shared record was accessed an average of 15 times over a 12-month period. The success of the Brisbane implementation relied on seven key factors: connectivity, interoperability, change management, clinical leadership, targeted patient involvement, information at the point of care, and governance. The Australian Commission on Safety and Quality in Health Care is currently evaluating the system for its potential to reduce errors relating to inadequate information transfer during clinical handover.

Future of electronic health records: implications for decision support.

Science.gov (United States)

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

The role of records management professionals in the national health ...

African Journals Online (AJOL)

The introduction of information communication technologies (ICTs) in the health sector has brought about electronic health (eHealth) which uses computing, networking and communications technologies to improve health delivery. However, the inclusion of records management and archival concerns during system design ...

Analysis of the security and privacy requirements of cloud-based electronic health records systems.

Science.gov (United States)

Rodrigues, Joel J P C; de la Torre, Isabel; Fernández, Gonzalo; López-Coronado, Miguel

2013-08-21

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

Development of archetypes of radiology for electronic health record

International Nuclear Information System (INIS)

Araujo, Tiago V.; Pires, Silvio R.; Paiva, Paulo B.

2013-01-01

This paper presents a proposal to develop archetypes for electronic patient records system based the openEHR Foundation model. Archetypes were developed specifically for the areas of radiology and diagnostic imaging, as for the early implementation of an electronic health records system. The archetypes developed are related to the examinations request, their execution and report, corresponding to both the administrative as diagnostic workflow inside a diagnostic imaging sector. (author)

76 FR 79685 - Privacy Act of 1974; System of Records Notice

Science.gov (United States)

2011-12-22

...) electronic health record implementation assistance from ONC grantees, (2) compare the evaluations to grantees... demographic information and characteristics of the electronic health records (EHR) systems and functionalities... 79686

A study of user requests regarding the fully electronic health record system at Seoul National University Bundang Hospital: challenges for future electronic health record systems.

Science.gov (United States)

Yoo, Sooyoung; Kim, Seok; Lee, Seungja; Lee, Kee-Hyuck; Baek, Rong-Min; Hwang, Hee

2013-05-01

Although the adoption rates for Electronic Health Records (EHRs) are growing, significant opportunities for further advances in EHR system design remain. The goal of this study was to identify issues that should be considered in the design process for the successful development of future systems by analyzing end users' service requests gathered during a recent three-year period after a comprehensive EHR system was implemented at Seoul National University's Bundang Hospital in South Korea. Data on 11,400 service requests from end users of the EHR system made from 2008 through 2010 were used in this study. The requests were categorized as program modification/development, data request, insurance-fee identification/generation, patient-record merging, or other. The authors further subcategorized the requests for program modification/development into the following nine areas of concern: (1) indicators and statistics, (2) patient safety and quality of care, (3) special task-oriented functionalities, (4) ease of use and user interface, (5) system speed, (6) interoperability and integration, (7) privacy and security, (8) customer service, and (9) miscellaneous. The system users were divided into four groups--direct care, care support, administrative/insurance, and general management--to identify each group's needs and concerns. The service requests for program modification/development, data request, insurance-fee identification/generation, patient-record merging, and other issues constituted approximately 49.2%, 33.9%, 11.4%, 4.0%, and 1.5% of the total data set, respectively. The number of data-request service requests grew over the three years studied. Different groups of users were found to have different concerns according to their activities and tasks. Within the program-modification/development category, end users were most frequently concerned with ease of use and user interface (38.1% of the total) and special task-oriented functionalities (29.3% of the total) in

42 CFR 491.10 - Patient health records.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Patient health records. 491.10 Section 491.10...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.10 Patient health records. (a) Records... systematically organized. (3) For each patient receiving health care services, the clinic or center maintains a...

The Copenhagen School Health Records Register

DEFF Research Database (Denmark)

Baker, Jennifer L; Sørensen, Thorkild I A

2011-01-01

The Copenhagen School Health Records Register is an electronic register of health examination information on 372,636 children who attended school in Copenhagen, Denmark from 1936 to 2005.......The Copenhagen School Health Records Register is an electronic register of health examination information on 372,636 children who attended school in Copenhagen, Denmark from 1936 to 2005....

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

Science.gov (United States)

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

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

Science.gov (United States)

Cunningham, James; Ainsworth, John

2017-01-01

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

Meeting the health information needs of prostate cancer patients using personal health records.

Science.gov (United States)

Pai, H H; Lau, F; Barnett, J; Jones, S

2013-12-01

There is interest in the use of health information technology in the form of personal health record (phr) systems to support patient needs for health information, care, and decision-making, particularly for patients with distressing, chronic diseases such as prostate cancer (pca). We sought feedback from pca patients who used a phr. For 6 months, 22 pca patients in various phases of care at the BC Cancer Agency (bcca) were given access to a secure Web-based phr called provider, which they could use to view their medical records and use a set of support tools. Feedback was obtained using an end-of-study survey on usability, satisfaction, and concerns with provider. Site activity was recorded to assess usage patterns. Of the 17 patients who completed the study, 29% encountered some minor difficulties using provider. No security breaches were known to have occurred. The two most commonly accessed medical records were laboratory test results and transcribed doctor's notes. Of survey respondents, 94% were satisfied with the access to their medical records, 65% said that provider helped to answer their questions, 77% felt that their privacy and confidentiality were preserved, 65% felt that using provider helped them to communicate better with their physicians, 83% found new and useful information that they would not have received by talking to their health care providers, and 88% said that they would continue to use provider. Our results support the notion that phrs can provide cancer patients with timely access to their medical records and health information, and can assist in communication with health care providers, in knowledge generation, and in patient empowerment.

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

Science.gov (United States)

Caine, Kelly; Hanania, Rima

2013-01-01

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

Capacity Building in Open Medical Record System (OpenMRS) in ...

International Development Research Centre (IDRC) Digital Library (Canada)

Capacity Building in Open Medical Record System (OpenMRS) in Rwanda ... Partners in Health (PIH), an international nongovernmental organization, has demonstrated the usefulness of ... Journal articles ... will fund social science, population and public health, and health systems research relevant to the emerging crisis.

[Shared electronic health record in Catalonia, Spain].

Science.gov (United States)

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

2010-02-01

Under the law adopted by its Parliament, the Government of Catalonia has developed an electronic medical record system for its National Health System (NHS). The model is governed by the following principles: 1) The citizen as owner of the data: direct access to his data and right to exercise his opposition's privileges; 2) Generate confidence in the system: security and confidentiality strength; 3) Shared model of information management: publishing system and access to organized and structured information, keeping in mind that the NHS of Catalonia is formally an "Integrated system of healthcare public use" (catalan acronym: SISCAT) with a wide variety of legal structures within its healthcare institutions; 4) Use of communication standards and catalogs as a need for technological and functional integration. In summary: single system of medical records shared between different actors, using interoperability tools and whose development is according to the legislation applicable in Catalonia and within its healthcare system. The result has been the establishment of a set of components and relation rules among which we highlight the following: 1) Display of information that collects sociodemographic data of the citizen, documents or reports (radiology, laboratory, therapeutic procedures, hospital release, emergency room), diagnostic health, prescription and immunization plus a summary screen with the most recent and relevant references; 2) Set of tools helping the user and direct messaging between professionals to facilitate their cooperation; 3) Model designed for supranational connections which will allow adding later, with ad hoc rules, clinical data provided by the private health sector or the proper citizen. 2010 Elsevier España S.L. All rights reserved.

Platform links clinical data with electronic health records

Science.gov (United States)

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

Indivo: a personally controlled health record for health information exchange and communication

Directory of Open Access Journals (Sweden)

Crawford William CR

2007-09-01

Full Text Available Abstract Background Personally controlled health records (PCHRs, a subset of personal health records (PHRs, enable a patient to assemble, maintain and manage a secure copy of his or her medical data. Indivo (formerly PING is an open source, open standards PCHR with an open application programming interface (API. Results We describe how the PCHR platform can provide standard building blocks for networked PHR applications. Indivo allows the ready integration of diverse sources of medical data under a patient's control through the use of standards-based communication protocols and APIs for connecting PCHRs to existing and future health information systems. Conclusion The strict and transparent personal control model is designed to encourage widespread participation by patients, healthcare providers and institutions, thus creating the ecosystem for development of innovative, consumer-focused healthcare applications.

Examining the Relationship between Electronic Health Record Interoperability and Quality Management

Science.gov (United States)

Purcell, Bernice M.

2013-01-01

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

Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review.

Science.gov (United States)

Syzdykova, Assel; Malta, André; Zolfo, Maria; Diro, Ermias; Oliveira, José Luis

2017-11-13

Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code

Electronic health records: eliciting behavioral health providers' beliefs.

Science.gov (United States)

Shank, Nancy; Willborn, Elizabeth; Pytlikzillig, Lisa; Noel, Harmonijoie

2012-04-01

Interviews with 32 community behavioral health providers elicited perceived benefits and barriers of using electronic health records. Themes identified were (a) quality of care, (b) privacy and security, and (c) delivery of services. Benefits to quality of care were mentioned by 100% of the providers, and barriers by 59% of providers. Barriers involving privacy and security concerns were mentioned by 100% of providers, and benefits by 22%. Barriers to delivery of services were mentioned by 97% of providers, and benefits by 66%. Most providers (81%) expressed overall positive support for electronic behavioral health records.

Progress along developmental tracks for electronic health records implementation in the United States

Directory of Open Access Journals (Sweden)

Hollar David W

2009-03-01

Full Text Available Abstract The development and implementation of electronic health records (EHR have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP, (b Regional Health Information Organization (RHIO demonstration projects to link together patient medical records, (c Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.

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

Science.gov (United States)

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

2018-01-01

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

Electronic Health Record developed by the Internet technology

OpenAIRE

吉原, 博幸; Yoshihara, Hiroyuki

1998-01-01

Installation of the order entry system had been done in the college hospital. However, Installation of the order entry system has just begun in middle sized hospitals. On the other hand, at the middle sized hospitals which does not equipped with the order entry system, the administrator is considering to install the electronic health record system rather than to install the order entry system, In case of small hospitals, there is no merit of installing the order entry system. So, many young d...

78 FR 22525 - Privacy Act of 1974; System of Records

Science.gov (United States)

2013-04-16

... 10-0004 System name: Occupational, Safety, Health, and Environmental Management Records (July 2, 2010...: Delete entry and replace with ``This system will manage occupational, safety, health, and environmental... Management System Office, 4800 Mark Center Drive; East Tower, 2nd Floor, Suite 02G09, Alexandria, VA 22350...

The Information Ecology of Personal Health Record Systems: Secure Messaging as Catalyst and Its Evolving Impact on Use and Consequences

Science.gov (United States)

Nazi, Kim M.

2012-01-01

Personal Health Records (PHRs) and PHR systems have been designed as consumer-oriented tools to empower patients and improve health care. Despite significant consumer interest and anticipated benefits, adoption remains low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications…

Electronic health records to facilitate clinical research

OpenAIRE

Cowie, Martin R.; Blomster, Juuso I.; Curtis, Lesley H.; Duclaux, Sylvie; Ford, Ian; Fritz, Fleur; Goldman, Samantha; Janmohamed, Salim; Kreuzer, J?rg; Leenay, Mark; Michel, Alexander; Ong, Seleen; Pell, Jill P.; Southworth, Mary Ross; Stough, Wendy Gattis

2016-01-01

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 pr...

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

Science.gov (United States)

Gomillion, David L.

2017-01-01

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

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

Science.gov (United States)

Rizvi, Rubina Fatima

2017-01-01

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

Using the Electronic Health Record in Nursing Research: Challenges and Opportunities.

Science.gov (United States)

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.

Exploring Type-and-Identity-Based Proxy Re-Encryption Scheme to Securely Manage Personal Health Records

NARCIS (Netherlands)

Ibraimi, L.; Gangopadhyay, Aryya; Tang, Qiang; Hartel, Pieter H.; Jonker, Willem

2010-01-01

Commercial Web-based Personal-Health Record (PHR) systems can help patients to share their personal health records (PHRs) anytime from anywhere. PHRs are very sensitive data and an inappropriate disclosure may cause serious problems to an individual. Therefore commercial Web-based PHR systems have

78 FR 54445 - Privacy Act Systems of Records; Phytosanitary Certificate Issuance and Tracking System

Science.gov (United States)

2013-09-04

... INFORMATION CONTACT: Mr. Christian B. Dellis, Export Services, Plant Health Programs, Plant Protection and... DEPARTMENT OF AGRICULTURE Office of the Secretary [Docket No. APHIS-2012-0104] Privacy Act Systems of Records; Phytosanitary Certificate Issuance and Tracking System AGENCY: Animal and Plant Health...

Risk assessment of integrated electronic health records.

Science.gov (United States)

Bjornsson, Bjarni Thor; Sigurdardottir, Gudlaug; Stefansson, Stefan Orri

2010-01-01

The paper describes the security concerns related to Electronic Health Records (EHR) both in registration of data and integration of systems. A description of the current state of EHR systems in Iceland is provided, along with the Ministry of Health's future vision and plans. New legislation provides the opportunity for increased integration of EHRs and further collaboration between institutions. Integration of systems, along with greater availability and access to EHR data, requires increased security awareness since additional risks are introduced. The paper describes the core principles of information security as it applies to EHR systems and data. The concepts of confidentiality, integrity, availability, accountability and traceability are introduced and described. The paper discusses the legal requirements and importance of performing risk assessment for EHR data. Risk assessment methodology according to the ISO/IEC 27001 information security standard is described with examples on how it is applied to EHR systems.

Quality Requirements for Electronic Health Record Systems*. A Japanese-German Information Management Perspective.

Science.gov (United States)

Winter, Alfred; Takabayashi, Katsuhiko; Jahn, Franziska; Kimura, Eizen; Engelbrecht, Rolf; Haux, Reinhold; Honda, Masayuki; Hübner, Ursula H; Inoue, Sozo; Kohl, Christian D; Matsumoto, Takehiro; Matsumura, Yasushi; Miyo, Kengo; Nakashima, Naoki; Prokosch, Hans-Ulrich; Staemmler, Martin

2017-08-07

For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.

Patient health record on a smart card.

Science.gov (United States)

Naszlady, A; Naszlady, J

1998-02-01

A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

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

Science.gov (United States)

England, S P

1993-11-01

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

Digital recording system

International Nuclear Information System (INIS)

Chandra, A.K.; Deshpande, S.V.; Iyer, A.; Vaidya, U.W.

1987-01-01

A large number of critical process parameters in nuclear power plants have hitherto been monitored using electromechanical chart recorders. The reducing costs of electronics systems have led to a trend towards modernizing power plant control rooms by computerizing all the panel instrumentation. As a first step, it has been decided to develop a digital recording system to record the values of 48 process parameters. The system as developed and described in this report is more than a replacement for recorders; it offers substantial advantages in terms of lower overall system cost, excellent time resolution, accurate data and absolute synchronization for correlated signals. The system provides high speed recording of 48 process parameters, maintains historical records and permits retrieval and display of archival information on a colour monitor, a plotter and a printer. It is implemented using a front end data acquisition unit connected on a serial link to a PC-XT computer with 20 MB Winchester. The system offers an extremely user friendly man machine interaction, based on a hierarchical paged menu driven scheme. Softwre development for this system has been carried out using the C language. (author). 9 figs

Implementation of a Novel Electronic Health Record-Embedded Physician Orders for Life-Sustaining Treatment System.

Science.gov (United States)

Zive, Dana M; Cook, Jennifer; Yang, Charissa; Sibell, David; Tolle, Susan W; Lieberman, Michael

2016-11-01

In April 2015, Oregon Health & Science University (OHSU) deployed a web-based, electronic medical record-embedded application created by third party vendor Vynca Inc. to allow real-time education, and completion of Physician Orders for Life Sustaining Treatment (POLST). Forms are automatically linked to the Epic Systems™ electronic health record (EHR) patient header and submitted to a state Registry, improving efficiency, accuracy, and rapid access to and retrieval of these important medical orders. POLST Forms, implemented in Oregon in 1992, are standardized portable medical orders used to document patient treatment goals for end-of-life care. In 2009, Oregon developed the first POLST-only statewide registry with a legislative mandate requiring POLST form signers to register the form unless the patient opts out. The Registry offers 24/7 emergency access to POLST Forms for Emergency Medical Services, Emergency Departments, and Acute Care Units. Because POLST is intended for those nearing end of life, immediate access to these forms at the time of an emergency is critical. Delays in registering a POLST Form may result in unwanted treatment if the paper form is not immediately available. An electronic POLST Form completion system (ePOLST) was implemented to support direct Registry submission. Other benefits of the system include single-sign-on, transmission of HL7 data for patient demographics and other relevant information, elimination of potential errors in form completion using internalized logic, built-in real-time video and text-based education materials for both patients and health care professionals, and mobile linkage for signature capture.

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

Science.gov (United States)

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.

Designing a system for patients controlling providers' access to their electronic health records: organizational and technical challenges.

Science.gov (United States)

Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M

2015-01-01

Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient

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

Science.gov (United States)

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

2017-11-01

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

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

Science.gov (United States)

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

2011-01-01

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

Electronic Health Record Implementation: A SWOT Analysis.

Science.gov (United States)

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.

Open source cardiology electronic health record development for DIGICARDIAC implementation

Science.gov (United States)

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

2015-12-01

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

A systematic literature review on security and privacy of electronic health record systems: technical perspectives.

Science.gov (United States)

Rezaeibagha, Fatemeh; Win, Khin Than; Susilo, Willy

Even though many safeguards and policies for electronic health record (EHR) security have been implemented, barriers to the privacy and security protection of EHR systems persist. This article presents the results of a systematic literature review regarding frequently adopted security and privacy technical features of EHR systems. Our inclusion criteria were full articles that dealt with the security and privacy of technical implementations of EHR systems published in English in peer-reviewed journals and conference proceedings between 1998 and 2013; 55 selected studies were reviewed in detail. We analysed the review results using two International Organization for Standardization (ISO) standards (29100 and 27002) in order to consolidate the study findings. Using this process, we identified 13 features that are essential to security and privacy in EHRs. These included system and application access control, compliance with security requirements, interoperability, integration and sharing, consent and choice mechanism, policies and regulation, applicability and scalability and cryptography techniques. This review highlights the importance of technical features, including mandated access control policies and consent mechanisms, to provide patients' consent, scalability through proper architecture and frameworks, and interoperability of health information systems, to EHR security and privacy requirements.

Innovative uses of electronic health records and social media for public health surveillance.

Science.gov (United States)

Eggleston, Emma M; Weitzman, Elissa R

2014-03-01

Electronic health records (EHRs) and social media have the potential to enrich public health surveillance of diabetes. Clinical and patient-facing data sources for diabetes surveillance are needed given its profound public health impact, opportunity for primary and secondary prevention, persistent disparities, and requirement for self-management. Initiatives to employ data from EHRs and social media for diabetes surveillance are in their infancy. With their transformative potential come practical limitations and ethical considerations. We explore applications of EHR and social media for diabetes surveillance, limitations to approaches, and steps for moving forward in this partnership between patients, health systems, and public health.

Integration of clinical research documentation in electronic health records.

Science.gov (United States)

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.

VA Personal Health Record Sample Data

Data.gov (United States)

Department of Veterans Affairs — My HealtheVet (www.myhealth.va.gov) is a Personal Health Record portal designed to improve the delivery of health care services to Veterans, to promote health and...

Electronic health records challenges in design and implementation

CERN Document Server

Sittig, Dean F

2013-01-01

This book provides an overview of the challenges in electronic health records (EHR) design and implementation along with an introduction to the best practices that have been identified over the past several years. The book examines concerns surrounding EHR use and proposes eight examples of proper EHR use. It discusses the complex strategic planning that accompanies the systemic organizational changes associated with EHR programs and highlights key lessons learned regarding health information-including technology errors and risk management concerns.

Teaching Electronic Health Record Communication Skills.

Science.gov (United States)

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

2016-06-01

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

Secure management of personal health records by applying attribute-based encryption

NARCIS (Netherlands)

Ibraimi, L.; Asim, M.; Petkovic, M.

2009-01-01

The confidentiality of personal health records is a major problem when patients use commercial Web-based systems to store their health data. Traditional access control mechanisms have several limitations with respect to enforcing access control policies and ensuring data confidentiality. In

Health Care Consumer's Perception of the Electronic Medical Record

African Journals Online (AJOL)

Method: A structured questionnaire was developed, validated and utilized in this quantitative research project. Quantitative data were collected ... Electronic Medical Records (EMR), as a health information technology innovation, has ... EMR will provide a highly effective, reliable, secure, and innovative information system.

Disturbance recording system

International Nuclear Information System (INIS)

Chandra, A.K.; Deshpande, S.V.; Mayya, A.; Vaidya, U.W.; Premraj, M.K.; Patil, N.B.

1994-01-01

A computerized system for disturbance monitoring, recording and display has been developed for use in nuclear power plants and is versatile enough to be used where ever a large number of parameters need to be recorded, e.g. conventional power plants, chemical industry etc. The Disturbance Recording System (DRS) has been designed to continuously monitor a process plant and record crucial parameters. The DRS provides a centralized facility to monitor and continuously record 64 process parameters scanned every 1 sec for 5 days. The system also provides facility for storage of 64 parameters scanned every 200 msec during 2 minutes prior to and 3 minutes after a disturbance. In addition the system can initiate, on demand, the recording of 8 parameters at a fast rate of every 5 msec for a period of 5 sec. and thus act as a visicorder. All this data is recorded in non-volatile memory and can be displayed, printed/plotted and used for subsequent analysis. Since data can be stored densely on floppy disks, the volume of space required for archival storage is also low. As a disturbance recorder, the DRS allows the operator to view the state of the plant prior to occurrence of the disturbance and helps in identifying the root cause. (author). 10 refs., 7 figs

Electronic health record case studies to advance environmental public health tracking.

Science.gov (United States)

Namulanda, Gonza; Qualters, Judith; Vaidyanathan, Ambarish; Roberts, Eric; Richardson, Max; Fraser, Alicia; McVeigh, Katharine H; Patterson, Scott

2018-03-01

Data from traditional public health surveillance systems can have some limitations, e.g., timeliness, geographic level, and amount of data accessible. Electronic health records (EHRs) could present an opportunity to supplement current sources of routinely collected surveillance data. The National Environmental Public Health Tracking Program (Tracking Program) sought to explore the use of EHRs for advancing environmental public health surveillance practices. The Tracking Program funded four state/local health departments to obtain and pilot the use of EHR data to address several issues including the challenges and technical requirements for accessing EHR data, and the core data elements required to integrate EHR data within their departments' Tracking Programs. The results of these pilot projects highlighted the potential of EHR data for public health surveillance of rare diseases that may lack comprehensive registries, and surveillance of prevalent health conditions or risk factors for health outcomes at a finer geographic level. EHRs therefore, may have potential to supplement traditional sources of public health surveillance data. Published by Elsevier Inc.

Secure Management of Personal Health Records by Applying Attribute-Based Encryption

NARCIS (Netherlands)

Ibraimi, L.; Asim, Muhammad; Petkovic, M.

2009-01-01

The confidentiality of personal health records is a major problem when patients use commercial Web-based systems to store their health data. Traditional access control mechanisms, such as Role-Based Access Control, have several limitations with respect to enforcing access control policies and

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

Science.gov (United States)

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

2014-01-01

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

76 FR 76956 - Privacy Act of 1974; System of Records

Science.gov (United States)

2011-12-09

... manager. Record source categories: Individual, social workers, rehabilitation counselors, and/or health... mental impairments and applicants for employment with Washington Headquarters Services/Human Resources... of records in the system: Storage: Paper file folders and electronic storage media. Retrievability...

Electronic Health Record Implementation: A SWOT Analysis

Directory of Open Access Journals (Sweden)

Leila Shahmoradi

2017-12-01

Full Text Available 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.

Towards lifetime electronic health record implementation.

Science.gov (United States)

Gand, Kai; Richter, Peggy; Esswein, Werner

2015-01-01

Integrated care concepts can help to diminish demographic challenges. Hereof, the use of eHealth, esp. overarching electronic health records, is recognized as an efficient approach. The article aims at rigorously defining the concept of lifetime electronic health records (LEHRs) and the identification of core factors that need to be fulfilled in order to implement such. A literature review was conducted. Existing definitions were identified and relevant factors were categorized. The derived assessment categories are demonstrated by a case study on Germany. Seven dimensions to differentiate types of electronic health records were found. The analysis revealed, that culture, regulation, informational self-determination, incentives, compliance, ICT infrastructure and standards are important preconditions to successfully implement LEHRs. The article paves the way for LEHR implementation and therewith for integrated care. Besides the expected benefits of LEHRs, there are a number of ethical, legal and social concerns, which need to be balanced.

The Future Is Coming: Electronic Health Records

Science.gov (United States)

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

Knowledge and attitudes of nurses in community health centres about electronic medical records

Directory of Open Access Journals (Sweden)

Don O’Mahony

2014-03-01

Full Text Available Background: Nurses in primary healthcare record data for the monitoring and evaluation of diseases and services. Information and communications technology (ICT can improve quality in healthcare by providing quality medical records. However, worldwide, the majority of health ICT projects have failed. Individual user acceptance is a crucial factor in successful ICT implementation. Objectives: The aim of this study is to explore nurses’ knowledge, attitudes and perceptions regarding ICT so as to inform the future implementation of electronic medical record (EMR systems. Methods: A qualitative design was used. Semi-structured interviews were undertaken with nurses at three community health centres (CHCs in the King Sabata Dalyindyebo Local Municipality. The interview guide was informed by the literature on user acceptance of ICT. Interviews were recorded and analysed using content analysis. Results: Many nurses knew about health ICT and articulated clearly the potential benefits of an EMR such as fewer errors, more complete records, easier reporting and access to information. They thought that an EMR system would solve the challenges they identified with the current paper-based record system, including duplication of data, misfiling, lack of a chronological patient record, excessive time in recording and reduced time for patient care. For personal ICT needs, approximately half used cellphone Internet-based services and computers. Conclusions: In this study, nurses identified many challenges with the current recording methods. They thought that an EMR should be installed at CHCs. Their knowledge about EMR, positive attitudes to ICT and personal use of ICT devices increase the likelihood of successful EMR implementation at CHCs.

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

Science.gov (United States)

Jensen, Tracey A.

2013-01-01

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

Validation of asthma recording in electronic health records: a systematic review

Directory of Open Access Journals (Sweden)

Nissen F

2017-12-01

Full Text Available Francis Nissen,1 Jennifer K Quint,2 Samantha Wilkinson,1 Hana Mullerova,3 Liam Smeeth,1 Ian J Douglas1 1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; 2National Heart and Lung Institute, Imperial College, London, UK; 3RWD & Epidemiology, GSK R&D, Uxbridge, UK Objective: To describe the methods used to validate asthma diagnoses in electronic health records and summarize the results of the validation studies. Background: Electronic health records are increasingly being used for research on asthma to inform health services and health policy. Validation of the recording of asthma diagnoses in electronic health records is essential to use these databases for credible epidemiological asthma research.Methods: We searched EMBASE and MEDLINE databases for studies that validated asthma diagnoses detected in electronic health records up to October 2016. Two reviewers independently assessed the full text against the predetermined inclusion criteria. Key data including author, year, data source, case definitions, reference standard, and validation statistics (including sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV] were summarized in two tables.Results: Thirteen studies met the inclusion criteria. Most studies demonstrated a high validity using at least one case definition (PPV >80%. Ten studies used a manual validation as the reference standard; each had at least one case definition with a PPV of at least 63%, up to 100%. We also found two studies using a second independent database to validate asthma diagnoses. The PPVs of the best performing case definitions ranged from 46% to 58%. We found one study which used a questionnaire as the reference standard to validate a database case definition; the PPV of the case definition algorithm in this study was 89%. Conclusion: Attaining high PPVs (>80% is possible using each of the discussed validation

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

Science.gov (United States)

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.

Towards the Application of Open Source Software in Developing National Electronic Health Record-Narrative Review Article.

Science.gov (United States)

Aminpour, Farzaneh; Sadoughi, Farahnaz; Ahmadi, Maryam

2013-12-01

Electronic Health Record (EHR) is a repository of patient health information shared among multiple authorized users. As a modern method of storing and processing health information, it is a solution for improving quality, safety and efficiency of patient care and health system. However, establishment of EHR requires a significant investment of time and money. While many of healthcare providers have very limited capital, application of open source software would be considered as a solution in developing national electronic health record especially in countries with low income. The evidence showed that financial limitation is one of the obstacles to implement electronic health records in developing countries. Therefore, establishment of an open source EHR system capable of modifications according to the national requirements seems to be inevitable in Iran. The present study identifies the impact of application of open source software in developing national electronic health record in Iran.

Electronic Health Records: An Enhanced Security Paradigm to Preserve Patient's Privacy

Science.gov (United States)

Slamanig, Daniel; Stingl, Christian

In recent years, demographic change and increasing treatment costs demand the adoption of more cost efficient, highly qualitative and integrated health care processes. The rapid growth and availability of the Internet facilitate the development of eHealth services and especially of electronic health records (EHRs) which are promising solutions to meet the aforementioned requirements. Considering actual web-based EHR systems, patient-centric and patient moderated approaches are widely deployed. Besides, there is an emerging market of so called personal health record platforms, e.g. Google Health. Both concepts provide a central and web-based access to highly sensitive medical data. Additionally, the fact that these systems may be hosted by not fully trustworthy providers necessitates to thoroughly consider privacy issues. In this paper we define security and privacy objectives that play an important role in context of web-based EHRs. Furthermore, we discuss deployed solutions as well as concepts proposed in the literature with respect to this objectives and point out several weaknesses. Finally, we introduce a system which overcomes the drawbacks of existing solutions by considering an holistic approach to preserve patient's privacy and discuss the applied methods.

Development and Deployment of the OpenMRS-Ebola Electronic Health Record System for an Ebola Treatment Center in Sierra Leone.

Science.gov (United States)

Oza, Shefali; Jazayeri, Darius; Teich, Jonathan M; Ball, Ellen; Nankubuge, Patricia Alexandra; Rwebembera, Job; Wing, Kevin; Sesay, Alieu Amara; Kanter, Andrew S; Ramos, Glauber D; Walton, David; Cummings, Rachael; Checchi, Francesco; Fraser, Hamish S

2017-08-21

Stringent infection control requirements at Ebola treatment centers (ETCs), which are specialized facilities for isolating and treating Ebola patients, create substantial challenges for recording and reviewing patient information. During the 2014-2016 West African Ebola epidemic, paper-based data collection systems at ETCs compromised the quality, quantity, and confidentiality of patient data. Electronic health record (EHR) systems have the potential to address such problems, with benefits for patient care, surveillance, and research. However, no suitable software was available for deployment when large-scale ETCs opened as the epidemic escalated in 2014. We present our work on rapidly developing and deploying OpenMRS-Ebola, an EHR system for the Kerry Town ETC in Sierra Leone. We describe our experience, lessons learned, and recommendations for future health emergencies. We used the OpenMRS platform and Agile software development approaches to build OpenMRS-Ebola. Key features of our work included daily communications between the development team and ground-based operations team, iterative processes, and phased development and implementation. We made design decisions based on the restrictions of the ETC environment and regular user feedback. To evaluate the system, we conducted predeployment user questionnaires and compared the EHR records with duplicate paper records. We successfully built OpenMRS-Ebola, a modular stand-alone EHR system with a tablet-based application for infectious patient wards and a desktop-based application for noninfectious areas. OpenMRS-Ebola supports patient tracking (registration, bed allocation, and discharge); recording of vital signs and symptoms; medication and intravenous fluid ordering and monitoring; laboratory results; clinician notes; and data export. It displays relevant patient information to clinicians in infectious and noninfectious zones. We implemented phase 1 (patient tracking; drug ordering and monitoring) after 2

Assessing Commercially Available Personal Health Records for Home Health: Recommendations for Design.

Science.gov (United States)

Kneale, Laura; Choi, Yong; Demiris, George

2016-01-01

Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.

Protecting patients’ electronic health records using enhanced active bundles

NARCIS (Netherlands)

Salih, R.M.; Lilien, L.T.; Ben Othmane, L.; Arriaga, R.; Matic, A.

2012-01-01

We propose a solution that provides protection for patients' electronic health/medical records disseminated among different authorized healthcare information systems. The solution is known as Active Bundles using a Trusted Third Party (ABTTP). It is based on the use of trusted third parties, and the

Implementation of Electronic Health Records in US Nursing Homes.

Science.gov (United States)

Bjarnadottir, Ragnhildur I; Herzig, Carolyn T A; Travers, Jasmine L; Castle, Nicholas G; Stone, Patricia W

2017-08-01

While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.

Deploying Electronic Health Record

African Journals Online (AJOL)

SOFTLINKS DIGITAL

[11] Verisign Whitepaper (2005) Managing Application Security in Business ... health record (EHR) and Information Technology and the subsequent impact of ... advancements, said that IT must play a ... and history of medical status and other.

Study of national registration systems for health records of radiation workers. National radiation dose registration system

International Nuclear Information System (INIS)

Nakagawa, Haruo; Kanda, Keiji

1999-01-01

A national radiation dose registration system is proposed in this paper. In Japan, only one radiation dose registration system is partly effective. It is applied for workers in nuclear power plants which are under control of regulatory laws for nuclear reactors. The total system was proposed previously by the Committee for Compensation Claims of Nuclear Accidents. The reason for the delay in establishing a registration system for all radiation workers is supposedly a lack of effort to adjust differences among items in radiation protection laws and the promotion of public acceptance to atomic power. Items about dose recordings, record keeping and dose-record reporting in all of the radiation regulatory laws are compared to each other, and items were extracted for revision. (author)

National electronic health records and the digital disruption of moral orders.

Science.gov (United States)

Garrety, Karin; McLoughlin, Ian; Wilson, Rob; Zelle, Gregor; Martin, Mike

2014-01-01

The digitalisation of patient health data to provide national electronic health record systems (NEHRS) is a major objective of many governments. Proponents claim that NEHRS will streamline care, reduce mistakes and cut costs. However, building these systems has proved highly problematic. Using recent developments in Australia as an example, we argue that a hitherto unexamined source of difficulty concerns the way NEHRS disrupt the moral orders governing the production, ownership, use of and responsibility for health records. Policies that pursue digitalisation as a self-evident 'solution' to problems in healthcare without due regard to these disruptions risk alienating key stakeholders. We propose a more emergent approach to the development and implementation of NEHRS that supports moral re-ordering around rights and responsibilities appropriate to the intentions of those involved in healthcare relationships. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Implementing Electronic Health Record Default Settings to Reduce Opioid Overprescribing: A Pilot Study.

Science.gov (United States)

Zivin, Kara; White, Jessica O; Chao, Sandra; Christensen, Anna L; Horner, Luke; Petersen, Dana M; Hobbs, Morgan R; Capreol, Grace; Halbritter, Kevin A; Jones, Christopher M

2018-01-09

To pilot test the effectiveness, feasibility, and acceptability of instituting a 15-pill quantity default in the electronic health record for new Schedule II opioid prescriptions. A mixed-methods pilot study in two health systems, including pre-post analysis of prescribed opioid quantity and focus groups or interviews with prescribers and health system administrators. We implemented a 15-pill electronic health record default for new Schedule II opioids and assessed opioid quantity before and after implementation using electronic health record data on 6,390 opioid prescriptions from 448 prescribers. We then analyzed themes from focus groups and interviews with four staff members and six prescribers. The proportion of opioid prescriptions for 15 pills increased at both sites after adding an electronic health record default, with one reaching statistical significance (from 4.1% to 7.2% at CHC, P = 0.280, and 15.9% to 37.2% at WVU, P default, although ease of implementation varied by electronic health record vendor. Most prescribers were not aware of the default change and stated that they made prescribing decisions based on patient clinical characteristics rather than defaults. This pilot provides initial evidence that changing default settings can increase the number of prescriptions at the default level. This low-cost and relatively simple intervention could have an impact on opioid overprescribing. However, default settings should be selected carefully to avoid unintended consequences. © 2018 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Knowledge and attitudes of nurses in community health centres about electronic medical records

Directory of Open Access Journals (Sweden)

Don O'Mahony

2014-02-01

Full Text Available Background: Nurses in primary healthcare record data for the monitoring and evaluation of diseases and services. Information and communications technology (ICT can improve quality in healthcare by providing quality medical records. However, worldwide, the majority of health ICT projects have failed. Individual user acceptance is a crucial factor in successful ICT implementation. Objectives: The aim of this study is to explore nurses’ knowledge, attitudes and perceptions regarding ICT so as to inform the future implementation of electronic medical record (EMR systems. Methods: A qualitative design was used. Semi-structured interviews were undertaken with nurses at three community health centres (CHCs in the King Sabata Dalyindyebo Local Municipality. The interview guide was informed by the literature on user acceptance of ICT. Interviews were recorded and analysed using content analysis. Results: Many nurses knew about health ICT and articulated clearly the potential benefits of an EMR such as fewer errors, more complete records, easier reporting and access to information. They thought that an EMR system would solve the challenges they identified with the current paper-based record system, including duplication of data, misfiling, lack of a chronological patient record, excessive time in recording and reduced time for patient care. For personal ICT needs, approximately half used cellphone Internet-based services and computers. Conclusions: In this study, nurses identified many challenges with the current recording methods. They thought that an EMR should be installed at CHCs. Their knowledge about EMR, positive attitudes to ICT and personal use of ICT devices increase the likelihood of successful EMR implementation at CHCs.

HOSPITAL INFORMATION SYSTEMS: A STUDY OF ELECTRONIC PATIENT RECORDS

Directory of Open Access Journals (Sweden)

Pedro Luiz Cortês

2011-05-01

Full Text Available The importance of patient records, also known as medical records, is related to different needs and objectives, as they constitute permanent documents on the health of patients. With the advancement of information technologies and systems, patient records can be stored in databases, resulting in a positive impact on patient care. Based on these considerations, a research question that arises is “what are the benefits and problems that can be seen with the use of electronic versions of medical records?” This question leads to the formulation of the following hypothesis: although problems can be identified during the process of using electronic record systems, the benefits outweigh the difficulties, thereby justifying their use. To respond to the question and test the presented hypothesis, a research study was developed with users of the same electronic record system, consisting of doctors, nurses, and administrative personnel in three hospitals located in the city of São Paulo, Brazil. The results show that, despite some problems in their usage, the benefits of electronic patient records outweigh possible disadvantages.

Quality and Electronic Health Records in Community Health Centers

Science.gov (United States)

Lesh, Kathryn A.

2014-01-01

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

Perioperative nurses' attitudes toward the electronic health record.

Science.gov (United States)

Yontz, Laura S; Zinn, Jennifer L; Schumacher, Edward J

2015-02-01

The adoption of an electronic health record (EHR) is mandated under current health care legislation reform. The EHR provides data that are patient centered and improves patient safety. There are limited data; however, regarding the attitudes of perioperative nurses toward the use of the EHR. The purpose of this project was to identify perioperative nurses' attitudes toward the use of the EHR. Quantitative descriptive survey was used to determine attitudes toward the electronic health record. Perioperative nurses in a southeastern health system completed an online survey to determine their attitudes toward the EHR in providing patient care. Overall, respondents felt the EHR was beneficial, did not add to the workload, improved documentation, and would not eliminate any nursing jobs. Nursing acceptance and the utilization of the EHR are necessary for the successful integration of an EHR and to support the goal of patient-centered care. Identification of attitudes and potential barriers of perioperative nurses in using the EHR will improve patient safety, communication, reduce costs, and empower those who implement an EHR. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Electronic records management in the public health sector of the ...

African Journals Online (AJOL)

Ngulup

records) ... cally related administrative decision-making and problem-solving. ... This implies that a successful e-health system needs maximum support from proper ...... disaster backup for recovery in case it is affected by disaster like fire and water.

Implementing the learning health care system.

NARCIS (Netherlands)

Verheij, R.; Barten, D.J.; Hek, K.; Nielen, M.; Prins, M.; Zwaanswijk, M.; Bakker, D. de

2014-01-01

Background: As computerisation of primary care facilities is rapidly increasing, a wealth of data is created in routinely recorded electronic health records (EHRs). This data can be used to create a true learning health care system, in which routinely available data are processed and analysed in

Mining Electronic Health Records using Linked Data.

Science.gov (United States)

Odgers, David J; Dumontier, Michel

2015-01-01

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

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

Science.gov (United States)

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.

An electronic health record for infertility clinics | Coetsee | South ...

African Journals Online (AJOL)

Objective. To design a user-friendly electronic health record system for infertility clinics (EHRIC) to capture quality data that will allow advanced audit and practice analysis, and to use the captured data for the South African Register of Assisted Reproductive Techniques (SARA) database and as a clinical research function.

Factors Affecting Usage of a Personal Health Record (PHR) to Manage Health

Science.gov (United States)

Taha, Jessica; Czaja, Sara J.; Sharit, Joseph; Morrow, Daniel G.

2018-01-01

As the health care industry shifts into the digital age, patients are increasingly being provided with access to electronic personal health records (PHRs) that are tethered to their provider-maintained electronic health records. This unprecedented access to personal health information can enable patients to more effectively manage their health, but little is actually known about patients’ ability to successfully use a PHR to perform health management tasks or the individual factors that influence task performance. This study evaluated the ability of 56 middle-aged adults (40–59 years) and 51 older adults (60–85 years) to use a simulated PHR to perform 15 common health management tasks encompassing medication management, review/interpretation of lab/test results, and health maintenance activities. Results indicated that participants in both age groups experienced significant difficulties in using the PHR to complete routine health management tasks. Data also showed that older adults, particularly those with lower numeracy and technology experience, encountered greater problems using the system. Furthermore, data revealed that the cognitive abilities predicting one’s task performance varied according to the complexity of the task. Results from this study identify important factors to consider in the design of PHRs so that they meet the needs of middle-aged and older adults. As deployment of PHRs is on the rise, knowledge of the individual factors that impact effective PHR use is critical to preventing an increase in health care disparities between those who are able to use a PHR and those who are not. PMID:24364414

Leveraging electronic health records for predictive modeling of post-surgical complications.

Science.gov (United States)

Weller, Grant B; Lovely, Jenna; Larson, David W; Earnshaw, Berton A; Huebner, Marianne

2017-01-01

Hospital-specific electronic health record systems are used to inform clinical practice about best practices and quality improvements. Many surgical centers have developed deterministic clinical decision rules to discover adverse events (e.g. postoperative complications) using electronic health record data. However, these data provide opportunities to use probabilistic methods for early prediction of adverse health events, which may be more informative than deterministic algorithms. Electronic health record data from a set of 9598 colorectal surgery cases from 2010 to 2014 were used to predict the occurrence of selected complications including surgical site infection, ileus, and bleeding. Consistent with previous studies, we find a high rate of missing values for both covariates and complication information (4-90%). Several machine learning classification methods are trained on an 80% random sample of cases and tested on a remaining holdout set. Predictive performance varies by complication, although an area under the receiver operating characteristic curve as high as 0.86 on testing data was achieved for bleeding complications, and accuracy for all complications compares favorably to existing clinical decision rules. Our results confirm that electronic health records provide opportunities for improved risk prediction of surgical complications; however, consideration of data quality and consistency standards is an important step in predictive modeling with such data.

Managing terminology assets in Electronic Health Records.

Science.gov (United States)

Abrams, Kelly; Schneider, Sue; Scichilone, Rita

2009-01-01

Electronic Health Record (EHR)systems rely on standard terminologies and classification systems that require both Information Technology (IT) and Information Management (IM) skills. Convergence of perspectives is necessary for effective terminology asset management including evaluation for use, maintenance and intersection with software applications. Multiple terminologies are necessary for patient care communication and data capture within EHRs and other information management tasks. Terminology asset management encompasses workflow and operational context as well as IT specifications and software application run time requirements. This paper identifies the tasks, skills and collaboration of IM and IT approaches for terminology asset management.

Biometrics for electronic health records.

Science.gov (United States)

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

2010-10-01

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

Clinical genomics in the world of the electronic health record.

Science.gov (United States)

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.

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system.

Science.gov (United States)

Rehem, Tania Cristina Morais Santa Barbara; de Oliveira, Maria Regina Fernandes; Ciosak, Suely Itsuko; Egry, Emiko Yoshikawa

2013-01-01

To estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. The hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. The sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH) was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. There are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

Directory of Open Access Journals (Sweden)

Tania Cristina Morais Santa Barbara Rehem

2013-09-01

Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

What is Clinical Safety in Electronic Health Care Record Systems?

Science.gov (United States)

Davies, George

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

Linking Health Records for Federated Query Processing

Directory of Open Access Journals (Sweden)

Dewri Rinku

2016-07-01

Full Text Available A federated query portal in an electronic health record infrastructure enables large epidemiology studies by combining data from geographically dispersed medical institutions. However, an individual’s health record has been found to be distributed across multiple carrier databases in local settings. Privacy regulations may prohibit a data source from revealing clear text identifiers, thereby making it non-trivial for a query aggregator to determine which records correspond to the same underlying individual. In this paper, we explore this problem of privately detecting and tracking the health records of an individual in a distributed infrastructure. We begin with a secure set intersection protocol based on commutative encryption, and show how to make it practical on comparison spaces as large as 1010 pairs. Using bigram matching, precomputed tables, and data parallelism, we successfully reduced the execution time to a matter of minutes, while retaining a high degree of accuracy even in records with data entry errors. We also propose techniques to prevent the inference of identifier information when knowledge of underlying data distributions is known to an adversary. Finally, we discuss how records can be tracked utilizing the detection results during query processing.

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

Science.gov (United States)

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

2015-08-01

There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document

Quality assurance records and records' system

International Nuclear Information System (INIS)

Link, M.; Martinek, J.

1980-01-01

For nuclear power plants extensive proof of quality is required which has to be documented reliably by quality records. With respect to the paper volume it is the most comprehensive 'curriculum vitae' of the technique. Traditional methods of information and recording are unsatisfactory for meeting regulatory requirements for maintaining the QA-aspects of status reporting, completeness, traceability and retrieval. Therefore KWU has established a record (documentation) subsystem within the overall component qualification system. Examples of the general documentation requirements, the procedure and handling in accordance with this subsystem for mechanical equipment are to be described examplarily. Topics are: - National and international requirements - Definition of QA records - Modular and product orientated KWU-record subsystem - Criteria for developing records - Record control, distribution, collection, storage - New documentation techniques (microfilm, data processing) - Education and training of personnel. (orig./RW)

National electronic medical records integration on cloud computing system.

Science.gov (United States)

Mirza, Hebah; El-Masri, Samir

2013-01-01

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

76 FR 4471 - Privacy Act of 1974; Report of Modified or Altered System of Records

Science.gov (United States)

2011-01-25

... 1974; Report of Modified or Altered System of Records AGENCY: Division of Respiratory Disease Studies... System of Records. SUMMARY: The Department of Health and Human Services proposes to alter System of... System of Records will be effective 40 days from the date submitted to the OMB, unless NIOSH receives...

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

Science.gov (United States)

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

2013-10-01

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

Designing a patient-centered personal health record to promote preventive care

Directory of Open Access Journals (Sweden)

Krist Alex H

2011-11-01

Full Text Available Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results

78 FR 47210 - National Practitioner Data Bank and Privacy Act; Exempt Records System; Technical Correction

Science.gov (United States)

2013-08-05

... reference cited in the Privacy Act regulations. The National Practitioner Data Bank (NPDB) system of records... DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 5b RIN 0906-AA97 National Practitioner Data Bank and Privacy Act; Exempt Records System; Technical Correction AGENCY: Health Resources and Services...

76 FR 81910 - Abolishment of Privacy Act System of Records

Science.gov (United States)

2011-12-29

... Program Manager, USDA, Forest Service, Office of Safety and Occupational and Health, 1400 Independence... Management Handbook (FSH) 6209.11. This system is abolished and removed from the inventory of the USDA System... DEPARTMENT OF AGRICULTURE Office of the Secretary Abolishment of Privacy Act System of Records...

Electronic Health Record in Continuous Shared Health Care

Czech Academy of Sciences Publication Activity Database

Hanzlíček, Petr; Zvárová, Jana; Zvára, K.; Bureš, V.; Špidlen, Josef

2005-01-01

Roč. 11, - (2005), s. 1-6 ISSN 1727-1983. [EMBEC'05. European Medical and Biomedical Conference /3./. Prague, 20.11.2005-25.11.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : electronic health record * shared health care * information technology Subject RIV: BD - Theory of Information

Electronic Health Record for Temporomandibular Joint Disorders – Support in Therapeutic Process

Czech Academy of Sciences Publication Activity Database

Hippmann, R.; Nagy, Miroslav; Dostálová, T.; Zvárová, Jana; Seydlová, M.; Feltlová, E.

2010-01-01

Roč. 6, č. 1 (2010), s. 27-32 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : electronic health record * automatic speech recognition * dental cross * temporomandibular joint * temporomandibular joint disorders * structured data entry * dentistry * data model * text-to-speech system * Research Diagnostic Criteria for TMD Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/en/ejbi/article/25-en- electronic - health - record -for-temporomandibular-joint-disorders-support-in-therapeutic-process.html

Are electronic health records ready for genomic medicine?

Science.gov (United States)

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.

A comparison of death recording by health centres and civil registration in South Africans receiving antiretroviral treatment.

Science.gov (United States)

Johnson, Leigh F; Dorrington, Rob E; Laubscher, Ria; Hoffmann, Christopher J; Wood, Robin; Fox, Matthew P; Cornell, Morna; Schomaker, Michael; Prozesky, Hans; Tanser, Frank; Davies, Mary-Ann; Boulle, Andrew

2015-01-01

There is uncertainty regarding the completeness of death recording by civil registration and by health centres in South Africa. This paper aims to compare death recording by the two systems, in cohorts of South African patients receiving antiretroviral treatment (ART). Completeness of death recording was estimated using a capture-recapture approach. Six ART programmes linked their patient record systems to the vital registration system using civil identity document (ID) numbers and provided data comparing the outcomes recorded in patient files and in the vital registration. Patients were excluded if they had missing/invalid IDs or had transferred to other ART programmes. After exclusions, 91,548 patient records were included. Of deaths recorded in patients files after 2003, 94.0% (95% CI: 93.3-94.6%) were recorded by civil registration, with completeness being significantly higher in urban areas, older adults and females. Of deaths recorded by civil registration after 2003, only 35.0% (95% CI: 34.2-35.8%) were recorded in patient files, with this proportion dropping from 60% in 2004-2005 to 30% in 2010 and subsequent years. Recording of deaths in patient files was significantly higher in children and in locations within 50 km of the health centre. When the information from the two systems was combined, an estimated 96.2% of all deaths were recorded (93.5% in children and 96.2% in adults). South Africa's civil registration system has achieved a high level of completeness in the recording of mortality. However, the fraction of deaths recorded by health centres is low and information from patient records is insufficient by itself to evaluate levels and predictors of ART patient mortality. Previously documented improvements in ART mortality over time may be biased if based only on data from patient records.

Effectiveness Of Security Controls On Electronic Health Records

Directory of Open Access Journals (Sweden)

Everleen Wanyonyi

2017-12-01

Full Text Available Electronic Health Record EHR systems enhance efficiency and effectiveness in handling patients information in healthcare. This study focused on the EHR security by initially establishing the nature of threats affecting the system and reviewing the implemented security safeguards. The study was done at a referral hospital level 6 government facility in Kenya. Purposive sampling was used to select a sample of 196 out of 385 staff and a questionnaire designed for qualitative data collection. Data was analyzed using SPSS software. Correlations and binary logistic regression were obtained. Binary Logistic Regression BLR was used to establish the effect of the safeguards predictors on EHR security. It was established that physical security contributes more to the security of an information system than administrative controls and technical controls in that order. BLR helped in predicting effective safeguards to control EHR security threats in limited resourced public health facilities.

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

Science.gov (United States)

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.

Direct and Electronic Health Record Access to the Clinical Decision Support for Immunizations in the Minnesota Immunization Information System.

Science.gov (United States)

Rajamani, Sripriya; Bieringer, Aaron; Wallerius, Stephanie; Jensen, Daniel; Winden, Tamara; Muscoplat, Miriam Halstead

2016-01-01

Immunization information systems (IIS) are population-based and confidential computerized systems maintained by public health agencies containing individual data on immunizations from participating health care providers. IIS hold comprehensive vaccination histories given across providers and over time. An important aspect to IIS is the clinical decision support for immunizations (CDSi), consisting of vaccine forecasting algorithms to determine needed immunizations. The study objective was to analyze the CDSi presentation by IIS in Minnesota (Minnesota Immunization Information Connection [MIIC]) through direct access by IIS interface and by access through electronic health records (EHRs) to outline similarities and differences. The immunization data presented were similar across the three systems examined, but with varying ability to integrate data across MIIC and EHR, which impacts immunization data reconciliation. Study findings will lead to better understanding of immunization data display, clinical decision support, and user functionalities with the ultimate goal of promoting IIS CDSi to improve vaccination rates.

Adaptations of Personal Health Record Platform for Medical Research on Chronic Diseases

Directory of Open Access Journals (Sweden)

A. Krukowski

2015-05-01

Full Text Available The article reports on experiences in e-Health platforms and services for supporting medical research into the causes and relationships among physiological parameters and health problems concerning different chronic diseases. The Personal Health Record (PHR is a way of standardizing electronic management of medical information between patients and their physicians, including medical bodies collaborating in providing integrated medical care services. We describe roles and aims behind electronic health records, follow with applicable legal and standardizations frameworks and relevant European activities, leading to the presentation of common commercial and open-source implementations of such systems, concluding with the indication of specific adaptations enabling a use of stored personal health data for scientific research into causes and evaluation of chronic illnesses. We describe ethical and privacy concerns that are relevant to using and exchanging electronic health information.

Using data from ambient assisted living and smart homes in electronic health records.

Science.gov (United States)

Knaup, P; Schöpe, L

2014-01-01

This editorial is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". To increase efficiency in the health care of the future, data from innovative technology like it is used for ambient assisted living (AAL) or smart homes should be available for individual health decisions. Integrating and aggregating data from different medical devices and health records enables a comprehensive view on health data. The objective of this paper is to present examples of the state of the art in research on information management that leads to a sustainable use and long-term storage of health data provided by innovative assistive technologies in daily living. Current research deals with the perceived usefulness of sensor data, the participatory design of visual displays for presenting monitoring data, and communication architectures for integrating sensor data from home health care environments with health care providers either via a regional health record bank or via a telemedical center. Integrating data from AAL systems and smart homes with data from electronic patient or health records is still in an early stage. Several projects are in an advanced conceptual phase, some of them exploring feasibility with the help of prototypes. General comprehensive solutions are hardly available and should become a major issue of medical informatics research in the near future.

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

Science.gov (United States)

Agno, Christina Farala; Guo, Kristina L

2013-01-01

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

Communication Patterns in the Perioperative Environment During Epic Electronic Health Record System Implementation.

Science.gov (United States)

Friend, Tynan H; Jennings, Samantha J; Levine, Wilton C

2017-02-01

In April 2016, Massachusetts General Hospital (MGH) went live with the Epic electronic health records (EHR) system, replacing a variety of EHRs that previously existed in different departments throughout the hospital. At the time of implementation, the Vocera® Badge Communication System, a wireless hands-free communication device distributed to perioperative team members, had increased perioperative communication flow and efficiency. As a quality improvement effort to better understand communication patterns during an EHR go-live, we monitored our Vocera call volume and user volume before, during and after our go-live. We noticed that call volume and user volume significantly increased during our immediate go-live period and quickly returned to baseline levels. We also noticed that call volume increased during periods of unplanned EHR downtime long after our immediate go-live period. When planning the implementation of a new EHR, leadership must plan for and support this critical communication need at the time of the go-live and must also be aware of these needs during unplanned downtime.

Healthcare technology innovation adoption electronic health records and other emerging health information technology innovations

CERN Document Server

Daim, Tugrul U; Basoglu, Nuri; Kök, Orhun M; Hogaboam, Liliya

2016-01-01

This book aims to study the factors affecting the adoption and diffusion of Health Information Technology (HIT) innovation. It analyzes the adoption processes of various tools and applications, particularly Electronic Health Records (EHR), highlighting the impact on various sectors of the healthcare system, such as physicians, administration,  and patient care, while also identifying the various pitfalls and gaps in the literature. With the various challenges currently facing the United States healthcare system, the study, adoption and diffusion of healthcare technology innovation, particularly HIT, is imperative to achieving national goals. This book is organized into three sections. Section one reviews theories and applications for the diffusion of Health Care Technologies. Section two evaluates EHR technology, including the barriers and enables in adoption and alternative technologies. Finally, section three examines the factors impacting the adoption of EHR systems. This book will be a key source for stu...

Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

Science.gov (United States)

Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F

2014-05-01

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

Macro influencers of electronic health records adoption.

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2018-02-22

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

Taming the EHR (Electronic Health Record) - There is Hope

Science.gov (United States)

DiAngi, YT; Longhurst, CA; Payne, TH

2016-01-01

With increasing diffusion of EHR technology over the last half decade, clinician burnout is rising. As healthcare is a complex and highly regulated field, the rapid and mass adoption of EHR technology has created disruption for highly skilled workers such as clinicians. Although, much has been written about dissatisfaction with the EHR (electronic health record), a paucity of immediate solutions exists in the literature. This article suggests three actionable steps health systems and clinicians can make to expedite gains from and mitigate the effect of the EHR on clinical practice. PMID:27830215

Project Management of a personnel radiation records computer system

International Nuclear Information System (INIS)

Labenski, T.

1984-01-01

Project Management techniques have been used to develop a data base management information system to provide storage and retrieval of personnel radiation and Health Physics records. The system is currently being developed on a Hewlett Packard 1000 Series E Computer with provisions to include plant radiation survey information, radiation work permit information, inventory management for Health Physics supplies and instrumentation, and control of personnel access to radiological controlled areas. The methodologies used to manage the overall project are presented along with selection and management of software vendors

Ethics and subsequent use of electronic health record data.

Science.gov (United States)

Lee, Lisa M

2017-07-01

The digital health landscape in the United States is evolving and electronic health record data hold great promise for improving health and health equity. Like many scientific and technological advances in health and medicine, there exists an exciting narrative about what we can do with the new technology, as well as reflection about what we should do with it based on what we value. Ethical reflections about the use of EHR data for research and quality improvement have considered the important issues of privacy and informed consent for subsequent use of data. Additional ethical aspects are important in the conversation, including data validity, patient obligation to participate in the learning health system, and ethics integration into training for all personnel who interact with personal health data. Attention to these ethical issues is paramount to our realizing the benefits of electronic health data. Published by Elsevier Inc.

The Relationship between Self-rated Health and Hospital Records

DEFF Research Database (Denmark)

Nielsen, Torben Heien

hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result, that SRH is a stronger predictor of mortality than objective health measures. The addition of future...... hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that SRH is able to capture diseases at prodromal stages and that with a sufficiently long time series of individual records, objective health measures can predict mortality......This paper investigates whether self-rated health (SRH) co-varies with individual hospital records. By linking the Danish Longitudinal Survey on Aging with individual hospital records covering all hospital admissions from 1995-2006, I show that SRH is correlated to historical, current, and future...

The Relationship between Self-Rated Health and Hospital Records

DEFF Research Database (Denmark)

Nielsen, Torben Heien

2013-01-01

hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result, that SRH is a stronger predictor of mortality than objective health measures. The addition of future...... hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that SRH is able to capture diseases at prodromal stages and that with a sufficiently long time series ofindividual records, objective health measures can predict mortality......This paper investigates whether self-rated health (SRH) co-varies with individual hospital records. By linking the Danish Longitudinal Survey on Aging with individual hospital records covering all hospital admissions from 1995-2006, I show that SRH is correlated to historical, current, and future...

The Relationship between Self-rated Health and Hospital Records

DEFF Research Database (Denmark)

Nielsen, Torben Heien

2016-01-01

, and future hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result that SRH is a stronger predictor of mortality than objective health measures. The addition...... of future hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that with a sufficiently long time series of individual records, objective health measures can predict mortality to the same extent as global self......This paper investigates whether self-rated health (SRH) covaries with individual hospital records. By linking the Danish Longitudinal Survey on Ageing with individual hospital records covering all hospital admissions from 1995 to 2006, I show that SRH is correlated to historical, current...

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

Science.gov (United States)

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.

An effective approach for choosing an electronic health record.

Science.gov (United States)

Rowley, Robert

2009-01-01

With government stimulus money becoming available to encourage healthcare facilities to adopt electronic health record (EHR) systems, the decision to move forward with implementing an EHR system has taken on an urgency not previously seen. The EHR landscape is evolving rapidly and the underlying technology platform is becoming increasingly interconnected. One must make sure that an EHR decision does not lock oneself into technology obsolescence. The best approach for evaluating an EHR is on the basis of:usability, interoperability, and affordability.

Reducing and Sustaining Duplicate Medical Record Creation by Usability Testing and System Redesign.

Science.gov (United States)

Khunlertkit, Adjhaporn; Dorissaint, Leonard; Chen, Allen; Paine, Lori; Pronovost, Peter J

2017-10-25

Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training. We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation. To evaluate system effectiveness, we compared the monthly potential duplicate medical record rates for preimplementation and postimplementation months. The existing system could not effectively handle a misspelling, which led to failed search and duplicate medical record creation. Using the existing system, 96% of registrars found commonly spelled patient names whereas only 69% successfully found complicated names. Registrars lacked knowledge and usage of a phonetic matching function to assist in misspelling. The new system consistently captured the correct patient regardless of misspelling, but search returned more potential matches, resulting in, on average, 4 seconds longer to select common names. Potential monthly duplicate medical record rate reduced by 38%, from 4% to 2.3% after implementation of the new system, and has sustained at an average of 2.5% for 2 years. Usability testing was an effective method to reveal problems and aid system redesign to deliver a more user friendly system, hence reducing the potential for medical record duplication. Greater standards for usability would ensure that these improvements can be realized before rather than after exposing patients to risks.

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

Science.gov (United States)

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

2015-09-01

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

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

Science.gov (United States)

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.

The SMART Platform: early experience enabling substitutable applications for electronic health records

Science.gov (United States)

Mandel, Joshua C; Murphy, Shawn N; Bernstam, Elmer Victor; Ramoni, Rachel L; Kreda, David A; McCoy, J Michael; Adida, Ben; Kohane, Isaac S

2012-01-01

Objective The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project seeks to develop a health information technology platform with substitutable applications (apps) constructed around core services. The authors believe this is a promising approach to driving down healthcare costs, supporting standards evolution, accommodating differences in care workflow, fostering competition in the market, and accelerating innovation. Materials and methods The Office of the National Coordinator for Health Information Technology, through the Strategic Health IT Advanced Research Projects (SHARP) Program, funds the project. The SMART team has focused on enabling the property of substitutability through an app programming interface leveraging web standards, presenting predictable data payloads, and abstracting away many details of enterprise health information technology systems. Containers—health information technology systems, such as electronic health records (EHR), personally controlled health records, and health information exchanges that use the SMART app programming interface or a portion of it—marshal data sources and present data simply, reliably, and consistently to apps. Results The SMART team has completed the first phase of the project (a) defining an app programming interface, (b) developing containers, and (c) producing a set of charter apps that showcase the system capabilities. A focal point of this phase was the SMART Apps Challenge, publicized by the White House, using http://www.challenge.gov website, and generating 15 app submissions with diverse functionality. Conclusion Key strategic decisions must be made about the most effective market for further disseminating SMART: existing market-leading EHR vendors, new entrants into the EHR market, or other stakeholders such as health information exchanges. PMID:22427539

Database system for management of health physics and industrial hygiene records

International Nuclear Information System (INIS)

Murdoch, B. T.; Blomquist, J. A.; Cooke, R. H.; Davis, J. T.; Davis, T. M.; Dolecek, E. H.; Halka-Peel, L.; Johnson, D.; Keto, D. N.; Reyes, L. R.; Schlenker, R. A.; Woodring; J. L.

1999-01-01

This paper provides an overview of the Worker Protection System (WPS), a client/server, Windows-based database management system for essential radiological protection and industrial hygiene. Seven operational modules handle records for external dosimetry, bioassay/internal dosimetry, sealed sources, routine radiological surveys, lasers, workplace exposure, and respirators. WPS utilizes the latest hardware and software technologies to provide ready electronic access to a consolidated source of worker protection

Electronic Health Record for Continuous Shared Health Care

Czech Academy of Sciences Publication Activity Database

Hanzlíček, Petr; Zvárová, Jana

2005-01-01

Roč. 9, - (2005), s. 275-280 ISSN 1335-2393. [YBERC 2005. Young Biomedical Engineers and Researchers Conference. Stará Lesná, 13.07.2005-15.07.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : information society * telemedicine * electronic health record * digital signature * personal data protection * biomedical informatics Subject RIV: FQ - Public Health Care, Social Medicine

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

Science.gov (United States)

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

2016-04-06

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

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

Directory of Open Access Journals (Sweden)

Marie-Pierre Gagnon

2016-07-01

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

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

Science.gov (United States)

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

Ethical issues in electronic health records: A general overview

Directory of Open Access Journals (Sweden)

Fouzia F Ozair

2015-01-01

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

Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse.

Science.gov (United States)

Verheij, Robert A; Curcin, Vasa; Delaney, Brendan C; McGilchrist, Mark M

2018-05-29

Enormous amounts of data are recorded routinely in health care as part of the care process, primarily for managing individual patient care. There are significant opportunities to use these data for other purposes, many of which would contribute to establishing a learning health system. This is particularly true for data recorded in primary care settings, as in many countries, these are the first place patients turn to for most health problems. In this paper, we discuss whether data that are recorded routinely as part of the health care process in primary care are actually fit to use for other purposes such as research and quality of health care indicators, how the original purpose may affect the extent to which the data are fit for another purpose, and the mechanisms behind these effects. In doing so, we want to identify possible sources of bias that are relevant for the use and reuse of these type of data. This paper is based on the authors' experience as users of electronic health records data, as general practitioners, health informatics experts, and health services researchers. It is a product of the discussions they had during the Translational Research and Patient Safety in Europe (TRANSFoRm) project, which was funded by the European Commission and sought to develop, pilot, and evaluate a core information architecture for the learning health system in Europe, based on primary care electronic health records. We first describe the different stages in the processing of electronic health record data, as well as the different purposes for which these data are used. Given the different data processing steps and purposes, we then discuss the possible mechanisms for each individual data processing step that can generate biased outcomes. We identified 13 possible sources of bias. Four of them are related to the organization of a health care system, whereas some are of a more technical nature. There are a substantial number of possible sources of bias; very little is

Bridging the gap: a virtual health record for integrated home care

Directory of Open Access Journals (Sweden)

Maria Hägglund

2007-06-01

Full Text Available Introduction: The coexistence of different information systems that are unable to communicate is a persistent problem in healthcare and in integrated home care in particular. Theory and methods: Physically federated integration is used for design of the underlying technical architecture to implement a mobile virtual health record for integrated home care. A user centered system development approach is followed during design and development of the system. Results: A technical platform based on a service-oriented approach where database functionality and services are separated has been developed. This guarantees flexibility with regard to changed functional demands and allows third party systems to interact with the platform in a standardized way. A physically federated integration enables point-of-care documentation, integrated presentation of information from different feeder systems, and offline access to data on handheld devices. Feeder systems deliver information in XML-files that are mapped against an ideal XML schema, published as an interface for integration with the information broker, and inserted into the mediator database. Conclusions: A seamless flow of information between both different care professionals involved in integrated home care and patients and relatives is provided through mobile information access and interaction with different feeder systems using the virtual health record.

Open source electronic health record and patient data management system for intensive care.

Science.gov (United States)

Massaut, Jacques; Reper, Pascal

2008-01-01

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

Electronic Health Records Place 1st at Indy 500

Science.gov (United States)

... 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 Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users

Science.gov (United States)

Pajunen, Tuuli; Saranto, Kaija; Lehtonen, Lasse

2016-01-01

Background The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system. Objective This study addresses two important questions: (1) “which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users?”, and (2) “which variables are associated with high- and extreme-risk severity ratings?” Methods This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach’s alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined. Results A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type “extended EHR unavailability”. The lowest overall risk level was associated with “selecting incorrectly from a list of items”. In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest (Prisk levels (PeLearning courses on EHR-use was associated with lower risk for some of the risk factors. Conclusions Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should be taken very seriously, particularly in operating rooms, procedure units, emergency departments, and intensive care units/critical care units. Health care organizations should use proactive and

76 FR 35050 - Privacy Act of 1974: New System of Records

Science.gov (United States)

2011-06-15

.../Central-15, Health Claims Data Warehouse, to its inventory of records systems subject to the Privacy Act.... The data warehouse will be fully compliant with all applicable provisions of the Privacy Act, Health... fully compliant with all applicable provisions of the Privacy Act, Federal Information Security...

The health literacy demands of electronic personal health records (e-PHRs): An integrative review to inform future inclusive research.

Science.gov (United States)

Hemsley, Bronwyn; Rollo, Megan; Georgiou, Andrew; Balandin, Susan; Hill, Sophie

2018-01-01

To integrate the findings of research on electronic personal health records (e-PHRs) for an understanding of their health literacy demands on both patients and providers. We sought peer-reviewed primary research in English addressing the health literacy demands of e-PHRs that are online and allow patients any degree of control or input to the record. A synthesis of three theoretical models was used to frame the analysis of 24 studies. e-PHRs pose a wide range of health literacy demands on both patients and health service providers. Patient participation in e-PHRs relies not only on their level of education and computer literacy, and attitudes to sharing health information, but also upon their executive function, verbal expression, and understanding of spoken and written language. The multiple health literacy demands of e-PHRs must be considered when implementing population-wide initiatives for storing and sharing health information using these systems. The health literacy demands of e-PHRs are high and could potentially exclude many patients unless strategies are adopted to support their use of these systems. Developing strategies for all patients to meet or reduce the high health literacy demands of e-PHRs will be important in population-wide implementation. Copyright © 2017 Elsevier B.V. All rights reserved.

75 FR 28264 - Privacy Act of 1974; Report of Systems of Record Notices

Science.gov (United States)

2010-05-20

....S.C. 290bb-31 et seq.). Protection and Advocacy for Individuals with Mental Illness Act of 1986 as... mental, alcohol, and/or drug abuse related illness. CATEGORIES OF RECORDS IN THE SYSTEM: The system... prevention, and the promotion of good physical and mental health. ROUTINE USES OF RECORDS MAINTAINED IN THE...

Transfer of information from personal health records: a survey of veterans using My HealtheVet.

Science.gov (United States)

Turvey, Carolyn L; Zulman, Donna M; Nazi, Kim M; Wakefield, Bonnie J; Woods, Susan S; Hogan, Timothy P; Weaver, Frances M; McInnes, Keith

2012-03-01

Personal health records provide patients with ownership of their health information and allow them to share information with multiple healthcare providers. However, the usefulness of these records relies on patients understanding and using their records appropriately. My HealtheVet is a Web-based patient portal containing a personal health record administered by the Veterans Health Administration. The goal of this study was to explore veterans' interest and use of My HealtheVet to transfer and share information as well as to identify opportunities to increase veteran use of the My HealtheVet functions. Two waves of data were collected in 2010 through an American Customer Satisfaction Index Web-based survey. A random sample of veterans using My HealtheVet was invited to participate in the survey conducted on the My HealtheVet portal through a Web-based pop-up browser window. Wave One results (n=25,898) found that 41% of veterans reported printing information, 21% reported saving information electronically, and only 4% ever sent information from My HealtheVet to another person. In Wave Two (n=18,471), 30% reported self-entering medication information, with 18% sharing this information with their Veterans Affairs (VA) provider and 9.6% sharing with their non-VA provider. Although veterans are transferring important medical information from their personal health records, increased education and awareness are needed to increase use. Personal health records have the potential to improve continuity of care. However, more research is needed on both the barriers to adoption as well as the actual impact on patient health outcomes and well-being.

Dental Electronic Health Record Evaluation

Czech Academy of Sciences Publication Activity Database

Chleborád, K.; Zvára Jr., Karel; Dostálová, T.; Zvára, Karel; Ivančáková, R.; Zvárová, Jana; Smidl, L.; Trmal, J.; Psutka, J.

2013-01-01

Roč. 1, č. 1 (2013), s. 50-50 ISSN 1805-8698. [EFMI 2013 Special Topic Conference. 17.04.2013-19.04.2013, Prague] Institutional support: RVO:67985807 Keywords : dentistry * medical documentation * electronic health record Subject RIV: IN - Informatics, Computer Science

Personal Health Records: A Systematic Literature Review.

Science.gov (United States)

Roehrs, Alex; da Costa, Cristiano André; Righi, Rodrigo da Rosa; de Oliveira, Kleinner Silva Farias

2017-01-06

Information and communication technology (ICT) has transformed the health care field worldwide. One of the main drivers of this change is the electronic health record (EHR). However, there are still open issues and challenges because the EHR usually reflects the partial view of a health care provider without the ability for patients to control or interact with their data. Furthermore, with the growth of mobile and ubiquitous computing, the number of records regarding personal health is increasing exponentially. This movement has been characterized as the Internet of Things (IoT), including the widespread development of wearable computing technology and assorted types of health-related sensors. This leads to the need for an integrated method of storing health-related data, defined as the personal health record (PHR), which could be used by health care providers and patients. This approach could combine EHRs with data gathered from sensors or other wearable computing devices. This unified view of patients' health could be shared with providers, who may not only use previous health-related records but also expand them with data resulting from their interactions. Another PHR advantage is that patients can interact with their health data, making decisions that may positively affect their health. This work aimed to explore the recent literature related to PHRs by defining the taxonomy and identifying challenges and open questions. In addition, this study specifically sought to identify data types, standards, profiles, goals, methods, functions, and architecture with regard to PHRs. The method to achieve these objectives consists of using the systematic literature review approach, which is guided by research questions using the population, intervention, comparison, outcome, and context (PICOC) criteria. As a result, we reviewed more than 5000 scientific studies published in the last 10 years, selected the most significant approaches, and thoroughly surveyed the health

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

Science.gov (United States)

Duftschmid, Georg; Chaloupka, Judith; Rinner, Christoph

2013-01-22

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

OmniPHR: A distributed architecture model to integrate personal health records.

Science.gov (United States)

Roehrs, Alex; da Costa, Cristiano André; da Rosa Righi, Rodrigo

2017-07-01

The advances in the Information and Communications Technology (ICT) brought many benefits to the healthcare area, specially to digital storage of patients' health records. However, it is still a challenge to have a unified viewpoint of patients' health history, because typically health data is scattered among different health organizations. Furthermore, there are several standards for these records, some of them open and others proprietary. Usually health records are stored in databases within health organizations and rarely have external access. This situation applies mainly to cases where patients' data are maintained by healthcare providers, known as EHRs (Electronic Health Records). In case of PHRs (Personal Health Records), in which patients by definition can manage their health records, they usually have no control over their data stored in healthcare providers' databases. Thereby, we envision two main challenges regarding PHR context: first, how patients could have a unified view of their scattered health records, and second, how healthcare providers can access up-to-date data regarding their patients, even though changes occurred elsewhere. For addressing these issues, this work proposes a model named OmniPHR, a distributed model to integrate PHRs, for patients and healthcare providers use. The scientific contribution is to propose an architecture model to support a distributed PHR, where patients can maintain their health history in an unified viewpoint, from any device anywhere. Likewise, for healthcare providers, the possibility of having their patients data interconnected among health organizations. The evaluation demonstrates the feasibility of the model in maintaining health records distributed in an architecture model that promotes a unified view of PHR with elasticity and scalability of the solution. Copyright © 2017 Elsevier Inc. All rights reserved.

Access Control Model for Sharing Composite Electronic Health Records

Science.gov (United States)

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

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

Current patient and healthcare worker attitudes to eHealth and the personally controlled electronic health record in major hospitals.

Science.gov (United States)

Armani, R; Mitchell, L E; Allen-Graham, J; Heriot, N R; Kotsimbos, T; Wilson, J W

2016-06-01

The current health system in Australia is comprised of both electronic- and paper-based medical records. The Federal Government has approved funding for the development of an individual health identifier and a universally adopted online health repository. To determine attitudes and beliefs of patients and healthcare workers regarding the use of stored medical information and the personally controlled electronic health record (PCEHR) in selected major hospitals in Victoria. Qualitative survey of patients and healthcare workers (n = 600 each group) conducted during 2014 across five major hospitals in Melbourne to measure the awareness, attitudes and barriers to electronic health and the PCEHR. Of the patients, 93.3% support the concept of a shared electronic healthcare record, 33.7% were aware of the PCEHR and only 11% had registered. The majority of healthcare workers believed that the presence of a shared health record would result in an increased appropriateness of care and patient safety by reducing adverse drug events and improving the timeliness of care provided. However, only 46% of healthcare workers were aware of the PCEHR. This study provides a baseline evaluation of perceptions surrounding eHealth and PCHER in acute health services in five metropolitan centres. While there appears to be a readiness for adoption of these strategies for healthcare documentation, patients require motivation to register for the PCEHR, and healthcare workers require more information on the potential benefits to them to achieve more timely and efficient care. © 2016 Royal Australasian College of Physicians.

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

Science.gov (United States)

Xu Chen; Berry, Damon; Stephens, Gaye

2015-01-01

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

Mobile health monitoring system for community health workers

CSIR Research Space (South Africa)

Sibiya, G

2014-09-01

Full Text Available of hypertension as it provides real time information and eliminates the need to visit a healthcare facility to take blood pressure readings. Our proposed mobile health monitoring system enables faster computerization of data that has been recorded... pressure, heart rate and glucose readings. These reading closely related to most common NCDs. D. Feedback to health worker and the subject of care Community health workers are often not professionally trained on health. As a result they are not expected...

78 FR 2363 - Notification of Deletion of a System of Records; Automated Trust Funds Database

Science.gov (United States)

2013-01-11

... [Docket No. APHIS-2012-0041] Notification of Deletion of a System of Records; Automated Trust Funds Database AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION: Notice of deletion of a system... establishing the Automated Trust Funds (ATF) database system of records. The Federal Information Security...

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

Science.gov (United States)

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

2016-01-01

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

Effects of a sexual health care nursing record on the attitudes and practice of oncology nurses.

Science.gov (United States)

Jung, Dukyoo; Kim, Jung-Hee

2016-10-01

A nursing record focused on sexual health care for patients with cancer could encourage oncology nurses to provide sexual health care for oncology patients in a simple and effective manner. However, existing electronic information systems focus on professional use and not sexual health care, which could lead to inefficiencies in clinical practice. To examine the effects of a sexual health care nursing record on the attitudes and practice of oncology nurses. Twenty-four full-time registered nurses caring for oncology patients were randomly assigned to the intervention and control groups in Korea. The researchers developed a sexual health care record and applied it to the intervention group for one month. Data were analyzed by Mann-Whitney U test and chi-square test. Content analysis was used to analyze interviews. Oncology nurses using the sexual health care record had significantly higher levels of sexual health care practice at 4 weeks post-intervention as compared to those who provided usual care to patients with cancer. A sexual health care record may have the potential to facilitate oncology nurses' practice of sexual health care. This study highlighted the importance of using SHC records with oncology patients to improve nursing practice related to sexuality issues. A nursing record focused on SHC for patients with cancer could make it easier and more effective for oncology nurses to provide such care to their patients. Copyright © 2016 Elsevier B.V. All rights reserved.

Blockchain Technology: A new secured Electronic Health Record System

OpenAIRE

Tamazirt , Lotfi; Alilat , Farid; Agoulmine , Nazim

2018-01-01

International audience; Nowadays, health systems are looking for effective ways to manage more patients in a shorter time, and to increase the quality of care through better coordination to provide quick, accurate and non-invasive diagnostics to patients. This paper aims to solve the dependence on trusted third parties by proposing a new management strategy, storage and security in a decentralized network through Blockchain technology. The proposed system also aims to offer a solution to help...

Nurses' Perceptions of the Electronic Health Record

Science.gov (United States)

Crawley, Rocquel Devonne

2013-01-01

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

Open source electronic health records and chronic disease management.

Science.gov (United States)

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

2014-02-01

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

Disassociation for electronic health record privacy.

Science.gov (United States)

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

2014-08-01

The dissemination of Electronic Health Record (EHR) data, beyond the originating healthcare institutions, can enable large-scale, low-cost medical studies that have the potential to improve public health. Thus, funding bodies, such as the National Institutes of Health (NIH) in the U.S., encourage or require the dissemination of EHR data, and a growing number of innovative medical investigations are being performed using such data. However, simply disseminating EHR data, after removing identifying information, may risk privacy, as patients can still be linked with their record, based on diagnosis codes. This paper proposes the first approach that prevents this type of data linkage using disassociation, an operation that transforms records by splitting them into carefully selected subsets. Our approach preserves privacy with significantly lower data utility loss than existing methods and does not require data owners to specify diagnosis codes that may lead to identity disclosure, as these methods do. Consequently, it can be employed when data need to be shared broadly and be used in studies, beyond the intended ones. Through extensive experiments using EHR data, we demonstrate that our method can construct data that are highly useful for supporting various types of clinical case count studies and general medical analysis tasks. Copyright © 2014 Elsevier Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Cresswell Kathrin M

2012-03-01

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

Health Information Systems.

Science.gov (United States)

Sirintrapun, S Joseph; Artz, David R

2015-06-01

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

Personal health records: Consumer attitudes toward privacy and security of their personal health information.

Science.gov (United States)

Lafky, Deborah Beranek; Horan, Thomas A

2011-03-01

Personal health record (PHR) systems are a subject of intense interest in the move to improve healthcare accessibility and quality. Although a number of vendors continue to put forward PHR systems, user-centered design research has lagged, and it has not been clear what features are important to prospective PHR users. Here, we report on a user-centered design study that combines qualitative and quantitative approaches to investigate several dimensions relevant to PHR design, and to look at the effect of health status on user needs. The results indicate that health status, especially disability and chronic illness, is relevant to PHR design. Further, the results provide empirical evidence about the role of privacy and security in users' attitudes toward PHR use. The exact nature of these attitudes differs from widely held perceptions about consumer values in healthcare information management. © The Author(s) 2011.

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

Science.gov (United States)

2010-06-15

... categories: Individual, social workers, rehabilitation counselors, and/or health care personnel. Exemptions... mental impairments and applicants for employment with Washington Headquarters Services/Human Resources... of records in the system: Storage: Paper files folders and electronic storage media. Retrievability...

EFFECTIVENESS OF INFORMATION SYSTEMS OF SELF RECORDING THE PATIENT TO THE DOCTOR IN ORDER TO COUNTER ABUSE IN THE PROVISION OF HEALTH SERVICES

Directory of Open Access Journals (Sweden)

V. P. Martsenyuk

2015-05-01

Full Text Available The article analyzes the procedure of implementation of information system of recording for consultation patients to specialists - health workers. It was shown the feasibility of an infor mation system selfrecor ding patients on admission. Are limited prospects improve quality of care through the implementation of the rights of patients to the same account.

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

Science.gov (United States)

2012-02-14

... usability of health information technology (HIT) systems, EHRs in particular, and performance-oriented user... the usability of health information technology (HIT) systems. NIST research is designed to: (1... DEPARTMENT OF COMMERCE National Institute of Standards and Technology [Docket No. 120123059-2058...

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

Science.gov (United States)

Lockett, Daeron C.

2014-01-01

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

Identifying Barriers in the Use of Electronic Health Records in Hawai‘i

Science.gov (United States)

Hamamura, Faith D; Hughes, Kira

2017-01-01

Hawai‘i faces unique challenges to Electronic Health Record (EHR) adoption due to physician shortages, a widespread distribution of Medically Underserved Areas and Populations (MUA/P), and a higher percentage of small independent practices. However, research on EHR adoption in Hawai‘i is limited. To address this gap, this article examines the current state of EHR in Hawai‘i, the barriers to adoption, and the future of Health Information Technology (HIT) initiatives to improve the health of Hawai‘i's people. Eight focus groups were conducted on Lana‘i, Maui, Hawai‘i Island, Kaua‘i, Moloka‘i, and O‘ahu. In these groups, a total of 51 diverse health professionals were asked about the functionality of EHR systems, barriers to use, facilitators of use, and what EHRs would look like in a perfect world. Responses were summarized and analyzed based on constant comparative analysis techniques. Responses were then clustered into thirteen themes: system compatibility, loss of productivity, poor interface, IT support, hardware/software, patient factors, education/training, noise in the system, safety, data quality concerns, quality metrics, workflow, and malpractice concerns. Results show that every group mentioned system compatibility. In response to these findings, the Health eNet Community Health Record initiative — which allows providers web-based access to patient health information from the patient's provider network— was developed as a step toward alleviating some of the barriers to sharing information between different EHRs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation will introduce a new payment model in 2017 that is partially based on EHR utilization. Therefore, more research should be done to understand EHR adoption and how this ruling will affect providers in Hawai‘i. PMID:28435756

Adoption of electronic health records and barriers

Directory of Open Access Journals (Sweden)

Venkataraman Palabindala

2016-10-01

Full Text Available Electronic health records (EHR are not a new idea in the U.S. medical system, but surprisingly there has been very slow adoption of fully integrated EHR systems in practice in both primary care settings and within hospitals. For those who have invested in EHR, physicians report high levels of satisfaction and confidence in the reliability of their system. There is also consensus that EHR can improve patient care, promote safe practice, and enhance communication between patients and multiple providers, reducing the risk of error. As EHR implementation continues in hospitals, administrative and physician leadership must actively investigate all of the potential risks for medical error, system failure, and legal responsibility before moving forward. Ensuring that physicians are aware of their responsibilities in relation to their charting practices and the depth of information available within an EHR system is crucial for minimizing the risk of malpractice and lawsuit. Hospitals must commit to regular system upgrading and corresponding training for all users to reduce the risk of error and adverse events.

75 FR 17938 - Privacy Act of 1974; Deletion of an Existing System of Records

Science.gov (United States)

2010-04-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Privacy Act of 1974; Deletion of an Existing System of Records AGENCY: Department of Health and Human Services... address comments to: Policy Director, Bureau of Clinician Recruitment and Service (BCRS), Health Resources...

Sharing Annotated Audio Recordings of Clinic Visits With Patients-Development of the Open Recording Automated Logging System (ORALS): Study Protocol.

Science.gov (United States)

Barr, Paul J; Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn

2017-07-06

Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth's Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a

Hospital Electronic Health Record Adoption and Its Influence on Postoperative Sepsis

Science.gov (United States)

Fareed, Naleef

2013-01-01

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

Electronic health records: what are the most important barriers?

Science.gov (United States)

Ayatollahi, Haleh; Mirani, Nader; Haghani, Hamid

2014-01-01

The process of design and adoption of electronic health records may face a number of barriers. This study aimed to compare the importance of the main barriers from the experts' point of views in Iran. This survey study was completed in 2011. The potential participants (62 experts) included faculty members who worked in departments of health information technology and individuals who worked in the Ministry of Health in Iran and were in charge of the development and adoption of electronic health records. No sampling method was used in this study. Data were collected using a Likert-scale questionnaire ranging from 1 to 5. The validity of the questionnaire was established using content and face validity methods, and the reliability was calculated using Cronbach's alpha coefficient. The response rate was 51.6 percent. The participants' perspectives showed that the most important barriers in the process of design and adoption of electronic health records were technical barriers (mean = 3.84). Financial and ethical-legal barriers, with the mean value of 3.80 were other important barriers, and individual and organizational barriers, with the mean values of 3.59 and 3.50 were found to be less important than other barriers from the experts' perspectives. Strategic planning for the creation and adoption of electronic health records in the country, creating a team of experts to assess the potential barriers and develop strategies to eliminate them, and allocating financial resources can help to overcome most important barriers to the adoption of electronic health records.

Structuring and coding in health care records: a qualitative analysis using diabetes as a case study.

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Robertson, Ann R R; Fernando, Bernard; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

2015-03-27

Globally, diabetes mellitus presents a substantial and increasing burden to individuals, health care systems and society. Structuring and coding of information in the electronic health record underpin attempts to improve sharing and searching for information. Digital records for those with long-term conditions are expected to bring direct and secondary uses benefits, and potentially to support patient self-management. We sought to investigate if how and why records for adults with diabetes were structured and coded and to explore a range of UK stakeholders' perceptions of current practice in the National Health Service. We carried out a qualitative, theoretically informed case study of documenting health care information for diabetes in family practice and hospital settings in England, using semi-structured interviews, observations, systems demonstrations and documentary data. We conducted 22 interviews and four on-site observations. With respect to secondary uses - research, audit, public health and service planning - interviewees clearly articulated the benefits of highly structured and coded diabetes data and it was believed that benefits would expand through linkage to other datasets. Direct, more marginal, clinical benefits in terms of managing and monitoring diabetes and perhaps encouraging patient self-management were also reported. We observed marked differences in levels of record structuring and/or coding between family practices, where it was high, and the hospital. We found little evidence that structured and coded data were being exploited to improve information sharing between care settings. Using high levels of data structuring and coding in records for diabetes patients has the potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK. A first step would be for hospitals to attain levels of health information technology infrastructure and systems use commensurate with family practices.

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

Science.gov (United States)

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

2009-03-01

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

Identifying patients with hypertension: a case for auditing electronic health record data.

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Baus, Adam; Hendryx, Michael; Pollard, Cecil

2012-01-01

Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3-1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5-1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9-1,377.9).

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

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Farri, Oladimeji Feyisetan

2012-01-01

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

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

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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.

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective.

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Sidek, Yusof Haji; Martins, Jorge Tiago

2017-11-01

Electronic health records (EHR) make health care more efficient. They improve the quality of care by making patients' medical history more accessible. However, little is known about the factors contributing to the successful EHR implementation in dental clinics. This article aims to identify the perceived critical success factors of EHR system implementation in a dental clinic context. We used Grounded Theory to analyse data collected in the context of Brunei's national EHR - the Healthcare Information and Management System (Bru-HIMS). Data analysis followed the stages of open, axial and selective coding. Six perceived critical success factors emerged: usability of the system, emergent behaviours, requirements analysis, training, change management, and project organisation. The study identified a mismatch between end-users and product owner/vendor perspectives. Workflow changes were significant challenges to clinicians' confident use, particularly as the system offered limited modularity and configurability. Recommendations are made for all the parties involved in healthcare information systems implementation to manage the change process by agreeing system goals and functionalities through wider consensual debate, and participated supporting strategies realised through common commitment. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

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

Science.gov (United States)

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.

77 FR 48984 - Privacy Act of 1974; System of Records Notice

Science.gov (United States)

2012-08-15

... Privacy Act systems, to facilitate their ability to respond to data security breach incidents (see OMB... DEPARTMENT OF HEALTH AND HUMAN SERVICES Privacy Act of 1974; System of Records Notice AGENCY...: In accordance with the requirements of the Privacy Act of 1974, HHS gives notice of a proposed...

Barriers Against Adoption of Electronic Health Record in Italy

Directory of Open Access Journals (Sweden)

Stefano Bonacina

2011-01-01

Full Text Available This work aims to expose the barriers which work against the satisfactory adoption and utilization of Electronic Health Records (EHRs in Italy. Experts from six operating areas were involved where barriers associated with practical daily use of EHRs might arise. Experts disclosed different barriers in their operating areas: the low interoperability of healthcare system infrastructures in diagnostic services; the lack of systems able to represent complex processes characterized by uncertainties in hospital wards; the unsatisfactory information exchange between heterogeneous healthcare providers in territorial healthcare; the lack of models and guidelines for administration process management; the lack of Health Information engineers who are recognized as professionals in Italian hospitals; the lack of domain vocabularies and ontologies for conceptual integration in clinical communication. Our findings suggest how future solutions must be designed considering the environment of specific areas.

78 FR 43258 - Privacy Act; System of Records: Human Resources Records, State-31

Science.gov (United States)

2013-07-19

... DEPARTMENT OF STATE [Public Notice 8384] Privacy Act; System of Records: Human Resources Records... system of records, Human Resources Records, State- 31, pursuant to the provisions of the Privacy Act of... State proposes that the current system will retain the name ``Human Resources Records'' (previously...

Deficiencies in radiation protection record systems

International Nuclear Information System (INIS)

Martin, J.B.; Lyon, M.

1991-01-01

Radiation protection records are a fundamental part of any program for protecting radiation workers. Records are essential to epidemiological studies of radiation workers and are becoming increasingly important as the number of radiation exposure litigation cases increases. Ready retrievability of comprehensive records is also essential to the adequate defense of a radiation protection program. Appraisals of numerous radiation protection programs have revealed that few record-keeping systems comply with American National Standards Institute, Standard Practice N13.6-1972. Record-keeping requirements and types of deficiencies in radiation protection records systems are presented in this paper, followed by general recommendations for implementing a comprehensive radiation protection records system

Deficiencies in radiation protection record systems

International Nuclear Information System (INIS)

Martin, J.B.; Lyon, M.

1991-01-01

Radiation protection records are a fundamental part of any program for protecting radiation workers. Records are essential to epidemiological studies of radiation workers and are becoming increasingly important as the number of radiation exposure litigation cases increases. Ready retrievability of comprehensive records is also essential to the adequate defense of a radiation protection program. Appraisals of numerous radiation protection programs have revealed that few record-keeping systems comply with American National Standards Institute, Standard Practice N13.6-1972. Record-keeping requirements and types of deficiencies in radiation protection records systems are presented in this paper, followed by general recommendations for implementing a comprehensive radiation protection records system. 8 refs

Privacy Act System of Records: EPA Telecommunications Detail Records, EPA-32

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Learn more about the EPA Telecommunications Detail Records System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedures.

Preserving medical correctness, readability and consistency in de-identified health records

DEFF Research Database (Denmark)

Pantazos, Kostas; Lauesen, Søren; Lippert, Søren

2016-01-01

A health record database contains structured data fields that identify the patient, such as patient ID, patient name, e-mail and phone number. These data are fairly easy to de-identify, that is, replace with other identifiers. However, these data also occur in fields with doctors’ free-text notes...... database, ending up with 323,122 patient health records. We had to invent many methods for de-identifying potential identifiers in the free-text notes. The de-identified health records should be used with caution for statistical purposes because we removed health records that were so special...

Towards a Personal Health Record System for the Assesment and Monitoring of Sedentary Behavior in Indoor Locations.

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Ceron, Jesus D; Lopez, Diego M

2016-01-01

Sedentary behavior has been associated to the development of noncommunicable diseases (NCD) such as cardiovascular diseases (CVD), type 2 diabetes, and cancer. Accelerometers and inclinometers have been used to estimate sedentary behaviors, however a major limitation is that these devices do not provide contextual information such as the activity performed, e.g., TV viewing, sitting at work, driving, etc. The main objective of the thesis is to propose and evaluate a Personal Health Record System to support the assessment and monitoring of sedentary behaviors. Until now, we have implemented a system, which identifies individual's sedentary behaviors and location based on accelerometer data obtained from a smartwatch, and symbolic location data obtained from Bluetooth beacons. The system infers sedentary behaviors by means of a supervised Machine Learning Classifier. The precision in the classification of the six studied sedentary behaviors exceeded 90%, being the Random Forest algorithm the most precise. The proposed system allows the recognition of specific sedentary behaviors and their location with very high precision.

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

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Bouamrane, Matt-Mouley; Mair, Frances S

2013-05-21

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

Health recommender systems: concepts, requirements, technical basics and challenges.

Science.gov (United States)

Wiesner, Martin; Pfeifer, Daniel

2014-03-03

During the last decades huge amounts of data have been collected in clinical databases representing patients' health states (e.g., as laboratory results, treatment plans, medical reports). Hence, digital information available for patient-oriented decision making has increased drastically but is often scattered across different sites. As as solution, personal health record systems (PHRS) are meant to centralize an individual's health data and to allow access for the owner as well as for authorized health professionals. Yet, expert-oriented language, complex interrelations of medical facts and information overload in general pose major obstacles for patients to understand their own record and to draw adequate conclusions. In this context, recommender systems may supply patients with additional laymen-friendly information helping to better comprehend their health status as represented by their record. However, such systems must be adapted to cope with the specific requirements in the health domain in order to deliver highly relevant information for patients. They are referred to as health recommender systems (HRS). In this article we give an introduction to health recommender systems and explain why they are a useful enhancement to PHR solutions. Basic concepts and scenarios are discussed and a first implementation is presented. In addition, we outline an evaluation approach for such a system, which is supported by medical experts. The construction of a test collection for case-related recommendations is described. Finally, challenges and open issues are discussed.

Health Recommender Systems: Concepts, Requirements, Technical Basics and Challenges

Directory of Open Access Journals (Sweden)

Martin Wiesner

2014-03-01

Full Text Available During the last decades huge amounts of data have been collected in clinical databases representing patients’ health states (e.g., as laboratory results, treatment plans, medical reports. Hence, digital information available for patient-oriented decision making has increased drastically but is often scattered across different sites. As as solution, personal health record systems (PHRS are meant to centralize an individual’s health data and to allow access for the owner as well as for authorized health professionals. Yet, expert-oriented language, complex interrelations of medical facts and information overload in general pose major obstacles for patients to understand their own record and to draw adequate conclusions. In this context, recommender systems may supply patients with additional laymen-friendly information helping to better comprehend their health status as represented by their record. However, such systems must be adapted to cope with the specific requirements in the health domain in order to deliver highly relevant information for patients. They are referred to as health recommender systems (HRS. In this article we give an introduction to health recommender systems and explain why they are a useful enhancement to PHR solutions. Basic concepts and scenarios are discussed and a first implementation is presented. In addition, we outline an evaluation approach for such a system, which is supported by medical experts. The construction of a test collection for case-related recommendations is described. Finally, challenges and open issues are discussed.

Safeguarding Confidentiality in Electronic Health Records.

Science.gov (United States)

Shenoy, Akhil; Appel, Jacob M

2017-04-01

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

Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD.

Science.gov (United States)

Navaneethan, Sankar D; Jolly, Stacey E; Schold, Jesse D; Arrigain, Susana; Nakhoul, Georges; Konig, Victoria; Hyland, Jennifer; Burrucker, Yvette K; Dann, Priscilla Davis; Tucky, Barbara H; Sharp, John; Nally, Joseph V

2017-09-07

Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record-based enhanced personal health record to disseminate CKD stage-specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4. Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: ( 1 ) enhanced personal health record only, ( 2 ) patient navigator only, ( 3 ) both, and ( 4 ) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates. Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups ( P =0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups. We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators

Building bridges across electronic health record systems through inferred phenotypic topics.

Science.gov (United States)

Chen, You; Ghosh, Joydeep; Bejan, Cosmin Adrian; Gunter, Carl A; Gupta, Siddharth; Kho, Abel; Liebovitz, David; Sun, Jimeng; Denny, Joshua; Malin, Bradley

2015-06-01

Data in electronic health records (EHRs) is being increasingly leveraged for secondary uses, ranging from biomedical association studies to comparative effectiveness. To perform studies at scale and transfer knowledge from one institution to another in a meaningful way, we need to harmonize the phenotypes in such systems. Traditionally, this has been accomplished through expert specification of phenotypes via standardized terminologies, such as billing codes. However, this approach may be biased by the experience and expectations of the experts, as well as the vocabulary used to describe such patients. The goal of this work is to develop a data-driven strategy to (1) infer phenotypic topics within patient populations and (2) assess the degree to which such topics facilitate a mapping across populations in disparate healthcare systems. We adapt a generative topic modeling strategy, based on latent Dirichlet allocation, to infer phenotypic topics. We utilize a variance analysis to assess the projection of a patient population from one healthcare system onto the topics learned from another system. The consistency of learned phenotypic topics was evaluated using (1) the similarity of topics, (2) the stability of a patient population across topics, and (3) the transferability of a topic across sites. We evaluated our approaches using four months of inpatient data from two geographically distinct healthcare systems: (1) Northwestern Memorial Hospital (NMH) and (2) Vanderbilt University Medical Center (VUMC). The method learned 25 phenotypic topics from each healthcare system. The average cosine similarity between matched topics across the two sites was 0.39, a remarkably high value given the very high dimensionality of the feature space. The average stability of VUMC and NMH patients across the topics of two sites was 0.988 and 0.812, respectively, as measured by the Pearson correlation coefficient. Also the VUMC and NMH topics have smaller variance of characterizing

Clinical Simulation and Workflow by use of two Clinical Information Systems, the Electronic Health Record and Digital Dictation

DEFF Research Database (Denmark)

Schou Jensen, Iben; Koldby, Sven

2013-01-01

digital dictation and the EHR (electronic health record) were simulated in realistic and controlled clinical environments. Useful information dealing with workflow and patient safety were obtained. The clinical simulation demonstrated that the EHR locks during use of the integration of digital dictation......Clinical information systems do not always support clinician workflows. An increasing number of unintended clinical inci-dents might be related to implementation of clinical infor-mation systems and to a new registration praxis of unin-tended clinical incidents. Evidence of performing clinical...... simulations before implementation of new clinical information systems provides the basis for use of this method. The intention has been to evaluate patient safety issues, functionality, workflow, and usefulness of a new solution before implementation in the hospitals. Use of a solution which integrates...

Integration of Hospital Information and Clinical Decision Support Systems to Enable the Reuse of Electronic Health Record Data.

Science.gov (United States)

Kopanitsa, Georgy

2017-05-18

The efficiency and acceptance of clinical decision support systems (CDSS) can increase if they reuse medical data captured during health care delivery. High heterogeneity of the existing legacy data formats has become the main barrier for the reuse of data. Thus, we need to apply data modeling mechanisms that provide standardization, transformation, accumulation and querying medical data to allow its reuse. In this paper, we focus on the interoperability issues of the hospital information systems (HIS) and CDSS data integration. Our study is based on the approach proposed by Marcos et al. where archetypes are used as a standardized mechanism for the interaction of a CDSS with an electronic health record (EHR). We build an integration tool to enable CDSSs collect data from various institutions without a need for modifications in the implementation. The approach implies development of a conceptual level as a set of archetypes representing concepts required by a CDSS. Treatment case data from Regional Clinical Hospital in Tomsk, Russia was extracted, transformed and loaded to the archetype database of a clinical decision support system. Test records' normalization has been performed by defining transformation and aggregation rules between the EHR data and the archetypes. These mapping rules were used to automatically generate openEHR compliant data. After the transformation, archetype data instances were loaded into the CDSS archetype based data storage. The performance times showed acceptable performance for the extraction stage with a mean of 17.428 s per year (3436 case records). The transformation times were also acceptable with 136.954 s per year (0.039 s per one instance). The accuracy evaluation showed the correctness and applicability of the method for the wide range of HISes. These operations were performed without interrupting the HIS workflow to prevent the HISes from disturbing the service provision to the users. The project results have proven that

Human-centered design of a personal health record system for metabolic syndrome management based on the ISO 9241-210:2010 standard

Directory of Open Access Journals (Sweden)

Farinango CD

2018-01-01

Full Text Available Charic D Farinango,1 Juan S Benavides,1 Jesús D Cerón,1 Diego M López,1 Rosa E Álvarez2 1Telematics Engineering Research Group, Faculty of Electronics and Telecommunications Engineering, Universidad del Cauca, Popayán, Colombia; 2Human Genetics Research Group, Faculty of Health Sciences, Universidad del Cauca, Popayán, Colombia Background: Previous studies have demonstrated the effectiveness of information and communication technologies to support healthy lifestyle interventions. In particular, personal health record systems (PHR-Ss empower self-care, essential to support lifestyle changes. Approaches such as the user-centered design (UCD, which is already a standard within the software industry (ISO 9241-210:2010, provide specifications and guidelines to guarantee user acceptance and quality of eHealth systems. However, no single PHR-S for metabolic syndrome (MS developed following the recommendations of the ISO 9241-210:2010 specification has been found in the literature.Objective: The aim of this study was to describe the development of a PHR-S for the management of MS according to the principles and recommendations of the ISO 9241-210 standard.Methods: The proposed PHR-S was developed using a formal software development process which, in addition to the traditional activities of any software process, included the principles and recommendations of the ISO 9241-210 standard. To gather user information, a survey sample of 1,187 individuals, eight interviews, and a focus group with seven people were performed. Throughout five iterations, three prototypes were built. Potential users of each system evaluated each prototype. The quality attributes of efficiency, effectiveness, and user satisfaction were assessed using metrics defined in the ISO/IEC 25022 standard.Results: The following results were obtained: 1 a technology profile from 1,187 ­individuals at risk for MS from the city of Popayan, Colombia, identifying that 75.2% of the people

Underserved Pregnant and Postpartum Women's Access and Use of Their Health Records.

Science.gov (United States)

Guo, Yuqing; Hildebrand, Janet; Rousseau, Julie; Brown, Brandon; Pimentel, Pamela; Olshansky, Ellen

The purpose of this study was to examine knowledge of and experiences with use of their electronic health record (EHR) among mostly Hispanic women during pregnancy and postpartum. Women who were in the MOMS Orange County prenatal or postpartum home visitation program completed surveys and participated in focus groups. Descriptive and content analyses were used. Twenty-six women participated. Nearly all women (24, 92.3%) knew what health records were and most (80.8%) felt that keeping their records would increase or greatly increase their confidence in caring for themselves and their families. Approximately one third reported already keeping a copy of their health records. Common barriers to accessing and understanding health records included healthcare providers' noncompliance with the Health Information Technology for Economic and Clinical Health Act, limited EHR adoption, unfriendly patient portals, complicated medical terminology, rushed appointments with healthcare providers, lack of Spanish interpreters, and lack of Spanish-speaking healthcare providers. Programs are needed to educate and support women and providers in using health records to promote health literacy, pregnancy management, and patient-provider relationships in underserved populations.

On-the-job training of health professionals for electronic health record and electronic medical record use: A scoping review

Directory of Open Access Journals (Sweden)

Valentina L. Younge

2015-09-01

Full Text Available The implementation of electronic health records (EHRs or electronic medical records (EMRs is well documented in health informatics literature yet, very few studies focus primarily on how health professionals in direct clinical care are trained for EHR or EMR use. Purpose: To investigate how health professionals in direct clinical care are trained to prepare them for EHR or EMR use. Methods: Systematic searches were conducted in CINAHL, EMBASE, Ovid MEDLINE, PsycINFO, PubMed and ISI WoS and, the Arksey and O’Malley scoping methodological framework was used to collect the data and analyze the results. Results: Training was done at implementation, orientation and post-implementation. Implementation and orientation training had a broader scope while post-implementation training focused on proficiency, efficiency and improvement. The multiplicity of training methods, types and levels of training identified appear to suggest that training is more effective when a combination of training methods are used.

Development and validation of an automated delirium risk assessment system (Auto-DelRAS) implemented in the electronic health record system.

Science.gov (United States)

Moon, Kyoung-Ja; Jin, Yinji; Jin, Taixian; Lee, Sun-Mi

2018-01-01

A key component of the delirium management is prevention and early detection. To develop an automated delirium risk assessment system (Auto-DelRAS) that automatically alerts health care providers of an intensive care unit (ICU) patient's delirium risk based only on data collected in an electronic health record (EHR) system, and to evaluate the clinical validity of this system. Cohort and system development designs were used. Medical and surgical ICUs in two university hospitals in Seoul, Korea. A total of 3284 patients for the development of Auto-DelRAS, 325 for external validation, 694 for validation after clinical applications. The 4211 data items were extracted from the EHR system and delirium was measured using CAM-ICU (Confusion Assessment Method for Intensive Care Unit). The potential predictors were selected and a logistic regression model was established to create a delirium risk scoring algorithm to construct the Auto-DelRAS. The Auto-DelRAS was evaluated at three months and one year after its application to clinical practice to establish the predictive validity of the system. Eleven predictors were finally included in the logistic regression model. The results of the Auto-DelRAS risk assessment were shown as high/moderate/low risk on a Kardex screen. The predictive validity, analyzed after the clinical application of Auto-DelRAS after one year, showed a sensitivity of 0.88, specificity of 0.72, positive predictive value of 0.53, negative predictive value of 0.94, and a Youden index of 0.59. A relatively high level of predictive validity was maintained with the Auto-DelRAS system, even one year after it was applied to clinical practice. Copyright © 2017. Published by Elsevier Ltd.

Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey

Science.gov (United States)

Rau, Hsiao-Hsien; Chen, Kang-Hua

2017-01-01

Background Empowering personal health records (PHRs) provides basic human right, awareness, and intention for health promotion. As health care delivery changes toward patient-centered services, PHRs become an indispensable platform for consumers and providers. Recently, the government introduced “My health bank,” a Web-based electronic medical records (EMRs) repository for consumers. However, it is not yet a PHR. To date, we do not have a platform that can let patients manage their own PHR. Objective This study creates a vision of a value-added platform for personal health data analysis and manages their health record based on the contents of the "My health bank." This study aimed to examine consumer expectation regarding PHR, using the importance-performance analysis. The purpose of this study was to explore consumer perception regarding this type of a platform: it would try to identify the key success factors and important aspects by using the importance-performance analysis, and give some suggestions for future development based on it. Methods This is a cross-sectional study conducted in Taiwan. Web-based invitation to participate in this study was distributed through Facebook. Respondents were asked to watch an introductory movie regarding PHR before filling in the questionnaire. The questionnaire was focused on 2 aspects, including (1) system functions, and (2) system design and security and privacy. The questionnaire would employ 12 and 7 questions respectively. The questionnaire was designed following 5-points Likert scale ranging from 1 (“disagree strongly”) to 5 (“Agree strongly”). Afterwards, the questionnaire data was sorted using IBM SPSS Statistics 21 for descriptive statistics and the importance-performance analysis. Results This research received 350 valid questionnaires. Most respondents were female (219 of 350 participants, 62.6%), 21-30 years old (238 of 350 participants, 68.0%), with a university degree (228 of 350 participants, 65

Obfuscatable multi-recipient re-encryption for secure privacy-preserving personal health record services.

Science.gov (United States)

Shi, Yang; Fan, Hongfei; Xiong, Guoyue

2015-01-01

With the rapid development of cloud computing techniques, it is attractive for personal health record (PHR) service providers to deploy their PHR applications and store the personal health data in the cloud. However, there could be a serious privacy leakage if the cloud-based system is intruded by attackers, which makes it necessary for the PHR service provider to encrypt all patients' health data on cloud servers. Existing techniques are insufficiently secure under circumstances where advanced threats are considered, or being inefficient when many recipients are involved. Therefore, the objectives of our solution are (1) providing a secure implementation of re-encryption in white-box attack contexts and (2) assuring the efficiency of the implementation even in multi-recipient cases. We designed the multi-recipient re-encryption functionality by randomness-reusing and protecting the implementation by obfuscation. The proposed solution is secure even in white-box attack contexts. Furthermore, a comparison with other related work shows that the computational cost of the proposed solution is lower. The proposed technique can serve as a building block for supporting secure, efficient and privacy-preserving personal health record service systems.

Electronic Health Records

Science.gov (United States)

... would likely trip an alarm within the hospital's computer system and start a trace on who tried to ... of what's involved in managing your own medical care . Some systems may let you interact with your health care ...

Recording routine forensic mental health evaluations should be a standard of practice in the 21st century.

Science.gov (United States)

Siegel, David M; Kinscherff, Robert

2018-04-25

The standard of practice for forensic interviews in criminal and delinquency cases, other than those conducted as part of brief preliminary screening evaluations or in emergency situations, should include a digital recording requirement. This standard should be adopted because of the greater availability of, and familiarity with, recording technology on the part of mental health professionals, the greater use and proven effectiveness of recording in other contexts of the criminal justice system, and the improvement in court presentation and accuracy of judicial determinations involving forensic assessments that recording will provide. The experience of practitioners with recording since professional associations last studied the issue should be taken into account, as informal data suggest it has been positive. Unfortunately, the legal system is unlikely to prompt this advance without its reconsideration by the forensic mental health professions, because current constitutional jurisprudence does not require recording and effectively makes it contingent upon request by examiners. Forensic evaluators thus have a valuable opportunity to educate the legal system on the utility and importance of this key reform, and so should adopt it as a best practice. Copyright © 2018 John Wiley & Sons, Ltd.

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

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Vreeman, Daniel J; Richoz, Christophe

2015-12-01

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

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

Science.gov (United States)

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.

Accessing Your Health Information: How can I access my health information and medical records?

Science.gov (United States)

... from the doctor’s office. Visit the Guide to Getting & Using Your Health Records for practical tips to help you access, review, and make the most of your health records. Open Survey Content last reviewed on April 4, 2018 Was this page helpful? Yes No Form Approved OMB# 0990-0379 Exp. Date ...

Evaluating the data completeness in the Electronic Health Record after the Implementation of an Outpatient Electronic Health Record.

Science.gov (United States)

Soto, Mauricio; Capurro, Daniel; Catalán, Silvia

2015-01-01

Electronic health records (EHRs) present an opportunity for quality improvement in health organitations, particularly at the primary health level. However, EHR implementation impacts clinical workflows, and physicians frequently prefer to document in a non-structured way, which ultimately hinders the ability to measure quality indicators. We present an assessment of data completeness-a key data quality indicator-during the first 12 months after the implementation of an EHR at a teaching outpatient center in Santiago, Chile.

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

Science.gov (United States)

Devries, Jennifer; Rafie, Sally; Polston, Gregory

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

Telematics and smart cards in integrated health information system.

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Sicurello, F; Nicolosi, A

1997-01-01

Telematics and information technology are the base on which it will be possible to build an integrated health information system to support population and improve their quality of life. This system should be based on record linkage of all data based on the interactions of the patients with the health structures, such as general practitioners, specialists, health institutes and hospitals, pharmacies, etc. The record linkage can provide the connection and integration of various records, thanks to the use of telematic technology (either urban or geographical local networks, such as the Internet) and electronic data cards. Particular emphasis should be placed on the introduction of smart cards, such as portable health cards, which will contain a standardized data set and will be sufficient to access different databases found in various health services. The inter-operability of the social-health records (including multimedia types) and the smart cards (which are one of the most important prerequisites for the homogenization and wide diffusion of these cards at an European level) should be strongly taken into consideration. In this framework a project is going to be developed aiming towards the integration of various data bases distributed territorially, from the reading of the software and the updating of the smart cards to the complete management of the patients' evaluation records, to the quality of the services offered and to the health planning. The applications developed will support epidemiological investigation software and data analysis. The inter-connection of all the databases of the various structures involved will take place through a coordination center, the most important system of which we will call "record linkage" or "integrated database". Smart cards will be distributed to a sample group of possible users and the necessary smart card management tools will be installed in all the structures involved. All the final users (the patients) in the whole

A microcomputer-based daily living activity recording system.

Science.gov (United States)

Matsuoka, Shingo; Yonezawa, Yoshiharu; Maki, Hiromichi; Ogawa, Hidekuni; Hahn, Allen W; Thayer, Julian F; Caldwell, W Morton

2003-01-01

A new daily living activity recording system has been developed for monitoring health conditions and living patterns, such as respiration, posture, activity/rest ratios and general activity level. The system employs a piezoelectric sensor, a dual axis accelerometer, two low-power active filters, a low-power 8-bit single chip microcomputer and a 128 MB compact flash memory. The piezoelectric sensor, whose electrical polarization voltage is produced by mechanical strain, detects body movements. Its high-frequency output components reflect body movements produced by walking and running activities, while the low frequency components are mainly respiratory. The dual axis accelerometer detects, from body X and Y tilt angles, whether the patient is standing, sitting or lying down (prone, supine, left side or right side). The detected respiratory, behavior and posture signals are stored by the compact flash memory. After recording, these data are downloaded to a desktop computer and analyzed.

The Impact of Electronic Health Records on Healthcare Professional's Beliefs and Attitudes toward Face to Face Communication

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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…

Text mining electronic health records to identify hospital adverse events

DEFF Research Database (Denmark)

Gerdes, Lars Ulrik; Hardahl, Christian

2013-01-01

Manual reviews of health records to identify possible adverse events are time consuming. We are developing a method based on natural language processing to quickly search electronic health records for common triggers and adverse events. Our results agree fairly well with those obtained using manu...

A Shared Decision-Making System for Diabetes Medication Choice Utilizing Electronic Health Record Data.

Science.gov (United States)

Wang, Yu; Li, Peng-Fei; Tian, Yu; Ren, Jing-Jing; Li, Jing-Song

2017-09-01

The use of a shared decision-making (SDM) process in antihyperglycemic medication strategy decisions is necessary due to the complexity of the conditions of diabetes patients. Knowledge of guidelines is used as decision aids in clinical situations, and during this process, no patient health conditions are considered. In this paper, we propose an SDM system framework for type-2 diabetes mellitus (T2DM) patients that not only contains knowledge abstracted from guidelines but also employs a multilabel classification model that uses class-imbalanced electronic health record (EHR) data and that aims to provide a recommended list of available antihyperglycemic medications to help physicians and patients have an SDM conversation. The use of EHR data to serve as a decision-support component in decision aids helps physicians and patients to reach a more intuitive understanding of current health conditions and allows the tailoring of the available knowledge to each patient, leading to a more effective SDM. Real-world data from 2542 T2DM inpatient EHRs were substituted by 77 features and eight output labels, i.e., eight antihyperglycemic medications, and these data were utilized to build and validate the recommendation model. The multilabel recommendation model exhibited stable performance in every single-label classification and showed the ability to predict minority positive cases in which the average recall value of the eight classes was 0.9898. As a whole multilabel classifier, the recommendation model demonstrated outstanding performance, with scores of 0.0941 for Hamming Loss, 0.7611 for Accuracy exam , 0.9664 for Recall exam , and 0.8269 for F exam .

Understanding Contrasting Approaches to Nationwide Implementations of Electronic Health Record Systems: England, the USA and Australia

Directory of Open Access Journals (Sweden)

Zoe Morrison

2011-01-01

Full Text Available As governments commit to national electronic health record (EHR systems, there is increasing international interest in identifying effective implementation strategies. We draw on Coiera's typology of national programmes - ‘top-down’, ‘bottom-up’ and ‘middle-out’ - to review EHR implementation strategies in three exemplar countries: England, the USA and Australia. In comparing and contrasting three approaches, we show how different healthcare systems, national policy contexts and anticipated benefits have shaped initial strategies. We reflect on progress and likely developments in the face of continually changing circumstances. Our review shows that irrespective of the initial strategy, over time there is likely to be convergence on the negotiated, devolved middle-out approach, which aims to balance the interests and responsibilities of local healthcare constituencies and national government to achieve national connectivity. We conclude that, accepting the current lack of empirical evidence, the flexibility offered by the middle-out approach may make this the best initial national strategy.

Validation of asthma recording in electronic health records: protocol for a systematic review.

Science.gov (United States)

Nissen, Francis; Quint, Jennifer K; Wilkinson, Samantha; Mullerova, Hana; Smeeth, Liam; Douglas, Ian J

2017-05-29

Asthma is a common, heterogeneous disease with significant morbidity and mortality worldwide. It can be difficult to define in epidemiological studies using electronic health records as the diagnosis is based on non-specific respiratory symptoms and spirometry, neither of which are routinely registered. Electronic health records can nonetheless be valuable to study the epidemiology, management, healthcare use and control of asthma. For health databases to be useful sources of information, asthma diagnoses should ideally be validated. The primary objectives are to provide an overview of the methods used to validate asthma diagnoses in electronic health records and summarise the results of the validation studies. EMBASE and MEDLINE will be systematically searched for appropriate search terms. The searches will cover all studies in these databases up to October 2016 with no start date and will yield studies that have validated algorithms or codes for the diagnosis of asthma in electronic health records. At least one test validation measure (sensitivity, specificity, positive predictive value, negative predictive value or other) is necessary for inclusion. In addition, we require the validated algorithms to be compared with an external golden standard, such as a manual review, a questionnaire or an independent second database. We will summarise key data including author, year of publication, country, time period, date, data source, population, case characteristics, clinical events, algorithms, gold standard and validation statistics in a uniform table. This study is a synthesis of previously published studies and, therefore, no ethical approval is required. The results will be submitted to a peer-reviewed journal for publication. Results from this systematic review can be used to study outcome research on asthma and can be used to identify case definitions for asthma. CRD42016041798. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

Health Reform in Minnesota: An Analysis of Complementary Initiatives Implementing Electronic Health Record Technology and Care Coordination.

Science.gov (United States)

Soderberg, Karen; Rajamani, Sripriya; Wholey, Douglas; LaVenture, Martin

2016-01-01

Minnesota enacted legislation in 2007 that requires all health care providers in the state to implement an interoperable electronic health record (EHR) system by 2015. 100% of hospitals and 98% of clinics had adopted EHR systems by end of 2015. Minnesota's 2008 health reform included a health care home (HCH) program, Minnesota's patient centered medical home. By end of 2014, 43% of HCH eligible clinics were certified with 335 certified HCHs and 430 eligible but not certified clinics. To study the association between adoption and use of EHRs in primary care clinics and HCH certification, including use of clinical decision support tools, patient registries, electronic exchange of patient information, and availability of patient portals. Study utilized data from the 2015 Minnesota Health Information Technology Clinic Survey conducted annually by the Minnesota Department of Health. The response rate was 80% with 1,181 of 1,473 Minnesota clinics, including 662 HCH eligible primary care clinics. The comparative analysis focused on certified HCHs (311) and eligible but not certified clinics (351). HCH clinics utilized the various tools of EHR technology at a higher rate than non-HCH clinics. This greater utilization was noted across a range of functionalities: clinical decision support, patient disease registries, EHR to support quality improvement, electronic exchange of summary care records and availability of patient portals. HCH certification was significant for clinical decision support tools, registries and quality improvement. HCH requirements of care management, care coordination and quality improvement can be better supported with EHR technology, which underscores the higher rate of utilization of EHR tools by HCH clinics. Optimizing electronic exchange of health information remains a challenge for all clinics, including HCH certified clinics. This research presents the synergy between complementary initiatives supporting EHR adoption and HCH certification

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

Science.gov (United States)

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 electronic health records than non-Magnet hospitals (Level 6 only: odds ratio = 3.68, P 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.

Views on health information sharing and privacy from primary care practices using electronic medical records.

Science.gov (United States)

Perera, Gihan; Holbrook, Anne; Thabane, Lehana; Foster, Gary; Willison, Donald J

2011-02-01

To determine how patients and physicians balance the perceived benefits and harms of sharing electronic health data for patient care and for secondary purposes. Before-after survey of patients and providers in practices using electronic medical records (EMRs) enrolled in a clinical trial in Ontario, Canada. Outcomes were measured using the Health Information Privacy Questionnaire (HIPQ) at baseline and end of study. Thirteen questions in 4 general domains investigated attitudes towards the privacy of EMRs, outsider's use of patient's health information, the sharing of patient's information within the health care system, and the overall perception of benefits versus harms of computerization in health care. 511 patients (mean age 60.3 years, 49.6% female) and 46 physicians (mean age 47.2 years, 37.0% female) participated. Most (>90%) supported the computerized sharing of the patient's health records among their health care professionals and to provide clinical advice. Fewer agreed that the patient's de-identified information should be shared outside of the health care circle (records can be keep more private than paper records (38-50%). Overall, a majority (58% patients, 70% physicians) believed that the benefits of computerization were greater than the risks of confidentiality loss. This was especially true for patients who were frequent computer users. While these primary care physicians and their patients valued the clinical features of EMRs, a substantial minority have concerns about the secondary use of de-identified information. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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

Science.gov (United States)

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 electronic health record introduction (P 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 and safety record of the nuclear industry

International Nuclear Information System (INIS)

Carter, M.W.; Carruthers, E.; Button, J.C.E.

1975-09-01

This paper examines the claim of the nuclear industry to have an excellent safety record, in terms of health and accident records of workers in the industry. It does not consider accidents which have not resulted in harm to the workers' health. The nuclear industry is considered to include all work with ionising radiations and radioactive materials, in education, research, medicine and industry. Since 'safety' is not an absolute concept, comparisons are made with the published records of other industries, and a study is made of the performance of the nuclear industry in relation to its own safety criteria. Data are presented on the radiation exposure of nuclear workers in Europe, America, India and Australia, in relation to the internationally recommended limits, and there is some discussion of the risks involved in these limits. The death rate in parts of the nuclear industry in America, the United Kingdom, and Australia is presented and compared with the death rate for other industries in those countries, and a listing is made of deaths caused by radiation in the period 1945 to 1968. Injury rates for the US and Australian nuclear industries are also compared with the injury rates for other industries in these countries. Consideration is given to the safety record of individual components of the nuclear industry (using the wide definition of this industry given above), special attention being given to health records of uranium miners, plutonium workers and radiologists. Although there are difficulties in obtaining sufficiently detailed information of this kind it is considered that the data presented, relative to any reasonable standard, demonstrate that the nuclear industry has a safety record to be proud of. (author)

78 FR 32256 - Privacy Act of 1974; Report of an Altered CMS System of Records Notice

Science.gov (United States)

2013-05-29

... 1974; Report of an Altered CMS System of Records Notice AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). ACTION: Altered System of Records Notice (SORN). SUMMARY: In accordance with the requirements of the Privacy Act of 1974 (5 USC 552a), CMS...

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

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... 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 ...

Casebook: a virtual patient iPad application for teaching decision-making through the use of electronic health records.

Science.gov (United States)

Bloice, Marcus D; Simonic, Klaus-Martin; Holzinger, Andreas

2014-08-07

Virtual Patients are a well-known and widely used form of interactive software used to simulate aspects of patient care that students are increasingly less likely to encounter during their studies. However, to take full advantage of the benefits of using Virtual Patients, students should have access to multitudes of cases. In order to promote the creation of collections of cases, a tablet application was developed which makes use of electronic health records as material for Virtual Patient cases. Because electronic health records are abundantly available on hospital information systems, this results in much material for the basis of case creation. An iPad-based Virtual Patient interactive software system was developed entitled Casebook. The application has been designed to read specially formatted patient cases that have been created using electronic health records, in the form of X-ray images, electrocardiograms, lab reports, and physician notes, and present these to the medical student. These health records are organised into a timeline, and the student navigates the case while answering questions regarding the patient along the way. Each health record can also be annotated with meta-information by the case designer, such as insight into the thought processes and the decision-making rationale of the physician who originally worked with the patient. Students learn decision-making skills by observing and interacting with real patient cases in this simulated environment. This paper discusses our approach in detail. Our group is of the opinion that Virtual Patient cases, targeted at undergraduate students, should concern patients who exhibit prototypical symptoms of the kind students may encounter when beginning their first medical jobs. Learning theory research has shown that students learn decision-making skills best when they have access to multitudes of patient cases and it is this plurality that allows students to develop their illness scripts effectively

Patient Perceptions of Electronic Health Records

Science.gov (United States)

Lulejian, Armine

2011-01-01

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

Do Electronic Health Records Help or Hinder Medical Education?

OpenAIRE

Peled, Jonathan U.; Sagher, Oren; Morrow, Jay B.; Dobbie, Alison E.

2009-01-01

Background to the Debate Background to the debate: Many countries worldwide are digitizing patients' medical records. In the United States, the recent economic stimulus package (?the American Recovery and Reinvestment Act of 2009?), signed into law by President Obama, includes $US17 billion in incentives for health providers to switch to electronic health records (EHRs). The package also includes $US2 billion for the development of EHR standards and best-practice guidelines. What impact will ...

Geometric data perturbation-based personal health record transactions in cloud computing.

Science.gov (United States)

Balasubramaniam, S; Kavitha, V

2015-01-01

Cloud computing is a new delivery model for information technology services and it typically involves the provision of dynamically scalable and often virtualized resources over the Internet. However, cloud computing raises concerns on how cloud service providers, user organizations, and governments should handle such information and interactions. Personal health records represent an emerging patient-centric model for health information exchange, and they are outsourced for storage by third parties, such as cloud providers. With these records, it is necessary for each patient to encrypt their own personal health data before uploading them to cloud servers. Current techniques for encryption primarily rely on conventional cryptographic approaches. However, key management issues remain largely unsolved with these cryptographic-based encryption techniques. We propose that personal health record transactions be managed using geometric data perturbation in cloud computing. In our proposed scheme, the personal health record database is perturbed using geometric data perturbation and outsourced to the Amazon EC2 cloud.

Geometric Data Perturbation-Based Personal Health Record Transactions in Cloud Computing

Science.gov (United States)

Balasubramaniam, S.; Kavitha, V.

2015-01-01

Cloud computing is a new delivery model for information technology services and it typically involves the provision of dynamically scalable and often virtualized resources over the Internet. However, cloud computing raises concerns on how cloud service providers, user organizations, and governments should handle such information and interactions. Personal health records represent an emerging patient-centric model for health information exchange, and they are outsourced for storage by third parties, such as cloud providers. With these records, it is necessary for each patient to encrypt their own personal health data before uploading them to cloud servers. Current techniques for encryption primarily rely on conventional cryptographic approaches. However, key management issues remain largely unsolved with these cryptographic-based encryption techniques. We propose that personal health record transactions be managed using geometric data perturbation in cloud computing. In our proposed scheme, the personal health record database is perturbed using geometric data perturbation and outsourced to the Amazon EC2 cloud. PMID:25767826

Geometric Data Perturbation-Based Personal Health Record Transactions in Cloud Computing

Directory of Open Access Journals (Sweden)

S. Balasubramaniam

2015-01-01

Full Text Available Cloud computing is a new delivery model for information technology services and it typically involves the provision of dynamically scalable and often virtualized resources over the Internet. However, cloud computing raises concerns on how cloud service providers, user organizations, and governments should handle such information and interactions. Personal health records represent an emerging patient-centric model for health information exchange, and they are outsourced for storage by third parties, such as cloud providers. With these records, it is necessary for each patient to encrypt their own personal health data before uploading them to cloud servers. Current techniques for encryption primarily rely on conventional cryptographic approaches. However, key management issues remain largely unsolved with these cryptographic-based encryption techniques. We propose that personal health record transactions be managed using geometric data perturbation in cloud computing. In our proposed scheme, the personal health record database is perturbed using geometric data perturbation and outsourced to the Amazon EC2 cloud.

Empirical advances with text mining of electronic health records.

Science.gov (United States)

Delespierre, T; Denormandie, P; Bar-Hen, A; Josseran, L

2017-08-22

Korian is a private group specializing in medical accommodations for elderly and dependent people. A professional data warehouse (DWH) established in 2010 hosts all of the residents' data. Inside this information system (IS), clinical narratives (CNs) were used only by medical staff as a residents' care linking tool. The objective of this study was to show that, through qualitative and quantitative textual analysis of a relatively small physiotherapy and well-defined CN sample, it was possible to build a physiotherapy corpus and, through this process, generate a new body of knowledge by adding relevant information to describe the residents' care and lives. Meaningful words were extracted through Standard Query Language (SQL) with the LIKE function and wildcards to perform pattern matching, followed by text mining and a word cloud using R® packages. Another step involved principal components and multiple correspondence analyses, plus clustering on the same residents' sample as well as on other health data using a health model measuring the residents' care level needs. By combining these techniques, physiotherapy treatments could be characterized by a list of constructed keywords, and the residents' health characteristics were built. Feeding defects or health outlier groups could be detected, physiotherapy residents' data and their health data were matched, and differences in health situations showed qualitative and quantitative differences in physiotherapy narratives. This textual experiment using a textual process in two stages showed that text mining and data mining techniques provide convenient tools to improve residents' health and quality of care by adding new, simple, useable data to the electronic health record (EHR). When used with a normalized physiotherapy problem list, text mining through information extraction (IE), named entity recognition (NER) and data mining (DM) can provide a real advantage to describe health care, adding new medical material and

Acceptability of a personally controlled health record in a community-based setting: implications for policy and design.

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Weitzman, Elissa R; Kaci, Liljana; Mandl, Kenneth D

2009-04-29

Consumer-centered health information systems that address problems related to fragmented health records and disengaged and disempowered patients are needed, as are information systems that support public health monitoring and research. Personally controlled health records (PCHRs) represent one response to these needs. PCHRs are a special class of personal health records (PHRs) distinguished by the extent to which users control record access and contents. Recently launched PCHR platforms include Google Health, Microsoft's HealthVault, and the Dossia platform, based on Indivo. To understand the acceptability, early impacts, policy, and design requirements of PCHRs in a community-based setting. Observational and narrative data relating to acceptability, adoption, and use of a personally controlled health record were collected and analyzed within a formative evaluation of a PCHR demonstration. Subjects were affiliates of a managed care organization run by an urban university in the northeastern United States. Data were collected using focus groups, semi-structured individual interviews, and content review of email communications. Subjects included: n = 20 administrators, clinicians, and institutional stakeholders who participated in pre-deployment group or individual interviews; n = 52 community members who participated in usability testing and/or pre-deployment piloting; and n = 250 subjects who participated in the full demonstration of which n = 81 initiated email communications to troubleshoot problems or provide feedback. All data were formatted as narrative text and coded thematically by two independent analysts using a shared rubric of a priori defined major codes. Sub-themes were identified by analysts using an iterative inductive process. Themes were reviewed within and across research activities (ie, focus group, usability testing, email content review) and triangulated to identify patterns. Low levels of familiarity with PCHRs were found as were high

DETAILED CLINICAL MODELS AND THEIR RELATION WITH ELECTRONIC HEALTH RECORDS.

OpenAIRE

Boscá Tomás, Diego

2016-01-01

[EN] Healthcare domain produces and consumes big quantities of people's health data. Although data exchange is the norm rather than the exception, being able to access to all patient data is still far from achieved. Current developments such as personal health records will introduce even more data and complexity to the Electronic Health Records (EHR). Achieving semantic interoperability is one of the biggest challenges to overcome in order to benefit from all the information contained in the ...

Military Health System Transformation Implications on Health Information Technology Modernization.

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Khan, Saad

2018-03-01

With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system. In this perspective, we discuss the implications of the intersection of two large-scope and large-scale initiatives, health system transformation, and information technology modernization, being rolled out in the largest and most complex federal agency and potential risk mitigating steps. The Military Health System will require an expanded unified clinical leadership to spearhead short-term transformation; furthermore, developing, organizing, and growing a cadre of informatics expertise to expand the use and diffusion of novel solutions such as health information exchanges, data analytics, and others to transcend organizational barriers are still needed to achieve the long-term aim of health system reform as envisioned by the National Defense Authorization Act for Fiscal Year 2017.