Proposed Electronic Medical Record with Emphasis on Hepatitis Diagnosis

Directory of Open Access Journals (Sweden)

Georgios Skapetis

2013-01-01

Full Text Available Introduction Medical domain is characterized, like many other domains, by an exponential evolution of the knowledge. There are a lot of tools which try to reduce the risk of error apparition in medical life. Medical decision becomes a very hard activity because the human experts, who have to make decisions, can hardly process the huge amounts of data. Diagnosis has a very important role here. It is the first step from a set of therapeutic actions, an error at this level can have dramatic consequences.The aim of this paper is to present a new electronic medical system for using it on patients with hepatitis virusinfection.Results: Hepatitis is a very complicated disease with numerous different types many of them can lead to serious diseases like cirrhosis and liver cancer. An early correct diagnosis and an adequate treatment could reduce the risks of liver cancer apparition or other severe diseases. The main goal of the system is to use artificial intelligence in order to offer predictions about patients infected with hepatitis virus and also to follow the healthcondition of the patient reevaluating at every time the initial diagnosis and suggesting tests and treatment. Our effort is to present a new electronic medical record that will “borrow” data from the standard health record of the patient and other resources where information is saved and will process it and give suggestions for the diagnosis and treatment of the patient and at the same time will use a simple operating environment, such as the internet, thus making it easy to use.Conclusions The medical record is a big step in improving health services in public hospitals. The proposed EMR with the use of artificial intelligence is the next logical step that will help in the diagnosis and early treatment of disease.

Medical Terminology of the Circulatory System. Medical Records. Instructional Unit for the Medical Transcriber.

Science.gov (United States)

Gosman, Minna L.

Developed as a result of an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis…

Medical Terminology of the Respiratory System. Medical Records. Instructional Unit for the Medical Transcriptionist.

Science.gov (United States)

Gosman, Minna L.

Following an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for…

Medical Terminology of the Musculoskeletal System. Medical Records. Instructional Unit for the Medical Transcriber.

Science.gov (United States)

Gosman, Minna L.

Following an analysis of the task of transcribing as practiced in a health facility, this study guide was developed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for a…

Making medical records professional(s).

Science.gov (United States)

Mason, A

1987-07-01

In 1986 a joint medical records project group was set up by the Institute of Health Services Management, the Association of Health Care Information and Medical Records Officers and the NHS Training Authority, with Mr Vic Peel as chairman. The group was supported by Arthur Andersen & Co, management consultants. The following is a shortened and edited version of an interim report drafted for the group by Dr Alastair Mason. It is intended for discussion and does not yet represent the definitive views of the sponsoring bodies.

Tips to Help Children through Their Medical Tests

Science.gov (United States)

... Resources For Health Professionals Subscribe Search Tips to Help Children through Their Medical Tests Send Us Your ... them through the procedure. A caring grownup can help the child cope with any physical pain or ...

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

Pervasive Electronic Medical Record

African Journals Online (AJOL)

Nafiisah

independent web service connected to database of medical records or Worldwide. Interoperability ... allows wireless monitoring and tracking of patients and first responders using sensor nodes .... All these network security threats arise mainly ...

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

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

2010-04-01

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

Controlled dissemination of Electronic Medical Records

NARCIS (Netherlands)

van 't Noordende, G.

2011-01-01

Building upon a security analysis of the Dutch electronic patient record system, this paper describes an approach to construct a fully decentralized patient record system, using controlled disclosure of references to medical records. This paper identifies several paths that can be used to disclose

Ethics of medical records and professional communications.

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Recupero, Patricia R

2008-01-01

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

Admission medical records made at night time have the same quality as day and evening time records.

Science.gov (United States)

Amirian, Ilda; Mortensen, Jacob F; Rosenberg, Jacob; Gögenur, Ismail

2014-07-01

A thorough and accurate admission medical record is an important tool in ensuring patient safety during the hospital stay. Surgeons' performance might be affected during night shifts due to sleep deprivation. The aim of the study was to assess the quality of admission medical records during day, evening and night time. A total of 1,000 admission medical records were collected from 2009 to 2013 based equally on four diagnoses: mechanical bowel obstruction, appendicitis, gallstone disease and gastrointestinal bleeding. The records were reviewed for errors by a pre-defined checklist based on Danish standards for admission medical records. The time of dictation for the medical record was registered. A total of 1,183 errors were found in 778 admission medical records made during day- and evening time, and 322 errors in 222 admission medical records from night time shifts. No significant overall difference in error was found in the admission medical records when day and evening values were compared to night values. Subgroup analyses made for all four diagnoses showed no difference in day and evening values compared with night time values. Night time deterioration was not seen in the quality of the medical records.

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

Science.gov (United States)

Gillum, Richard F

2013-10-01

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

[Nurse's coworking to electronic medical record].

Science.gov (United States)

Maresca, M; Gavaciuto, D; Cappelli, G

2007-01-01

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

[Reliability of Primary Care computerised medication records].

Science.gov (United States)

García-Molina Sáez, Celia; Urbieta Sanz, Elena; Madrigal de Torres, Manuel; Piñera Salmerón, Pascual; Pérez Cárceles, María D

2016-03-01

To quantify and to evaluate the reliability of Primary Care (PC) computerised medication records of as an information source of patient chronic medications, and to identify associated factors with the presence of discrepancies. A descriptive cross-sectional study. General Referral Hospital in Murcia. Patients admitted to the cardiology-chest diseases unit, during the months of February to April 2013, on home treatment, who agreed to participate in the study. Evaluation of the reliability of Primary Care computerised medication records by analysing the concordance, by identifying discrepancies, between the active medication in these records and that recorded in pharmacist interview with the patient/caregiver. Identification of associated factors with the presence of discrepancies was analysed using a multivariate logistic regression. The study included a total of 308 patients with a mean of 70.9 years (13.0 SD). The concordance of active ingredients was 83.7%, and this decreased to 34.7% when taking the dosage into account. Discrepancies were found in 97.1% of patients. The most frequent discrepancy was omission of frequency (35.6%), commission (drug added unjustifiably) (14.6%), and drug omission (12.7%). Age older than 65 years (1.98 [1.08 to 3.64]), multiple chronic diseases (1.89 [1.04 to 3.42]), and have a narcotic or psychotropic drug prescribed (2.22 [1.16 to 4.24]), were the factors associated with the presence of discrepancies. Primary Care computerised medication records, although of undoubted interest, are not be reliable enough to be used as the sole source of information on patient chronic medications when admitted to hospital. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

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

Science.gov (United States)

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

2015-01-01

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

Implementation of an Electronic Medical Records System

Science.gov (United States)

2008-05-07

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

Product-line administration: a framework for redefining medical record department services.

Science.gov (United States)

Postal, S N

1990-06-01

Product-line administration is a viable approach for managing medical records services in an environment that demands high quantity and quality service levels. Product-line administration directs medical record department team members to look outside of the department and seek input from the customers it is intended to serve. The feedback received may be alarming at first, as the current state of products usually reveals a true lack of customer input. As the planning, defining, managing, and marketing phases are implemented, the road will not be easy and rewards will be slow to come. Product-line administration does not provide quick fixes, but it does provide long-term problem resolution as products are refined and new products developed to meet customer needs and expectations. In addition to better meeting the needs of the department's external customers, the department's internal customers' needs and expectations will be addressed. The participative management approach will help nurture each team member's creativity. The team members will have the opportunity to reach their full potential while reaping the rewards and benefits of providing products and services that meet the needs and expectations of all department customers. The future of the health care industry promises more changes as the country moves toward some form of prospective payment in the ambulatory setting. Reactive management and the constant struggle to catch up can no longer be accepted as a management approach. It is imperative that the medical record department be viewed as a business with product lines composed of quality products. The planning, defining, managing, and marketing components of product-line administration afford responsiveness to the current situation and the development of quality products that will ensure that medical record departments are prepared for the future.

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

Science.gov (United States)

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

2009-12-01

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

Collaborative Affordances of Hybrid Patient Record Technologies in Medical Work

DEFF Research Database (Denmark)

Houben, Steven; Frost, Mads; Bardram, Jakob E

2015-01-01

explored the integration of paper and digital technology, there are still a wide range of open issues in the design of technologies that integrate digital and paper-based medical records. This paper studies the use of one such novel technology, called the Hybrid Patient Record (HyPR), that is designed......The medical record is a central artifact used to organize, communicate and coordinate information related to patient care. Despite recent deployments of electronic health records (EHR), paper medical records are still widely used because of the affordances of paper. Although a number of approaches...... to digitally augment a paper medical record. We report on two studies: a field study in which we describe the benefits and challenges of using a combination of electronic and paper-based medical records in a large university hospital and a deployment study in which we analyze how 8 clinicians used the Hy...

Towards Semantic Search and Inference in Electronic Medical Records

Directory of Open Access Journals (Sweden)

Bevan Koopman

2012-09-01

Full Text Available Background This paper presents a novel approach to searching electronic medical records that is based on concept matching rather than keyword matching. Aims The concept-based approach is intended to overcome specific challenges we identified in searching medical records. Method Queries and documents were transformed from their term-based originals into medical concepts as defined by the SNOMED-CT ontology. Results Evaluation on a real-world collection of medical records showed our concept-based approach outperformed a keyword baseline by 25% in Mean Average Precision. Conclusion The concept-based approach provides a framework for further development of inference based search systems for dealing with medical data.

The use of shared medication record as part of medication reconciliation at hospital admission is feasible

DEFF Research Database (Denmark)

Munck, Lars K; Hansen, Karina R; Mølbak, Anne Grethe

2014-01-01

INTRODUCTION: Medication reconciliation improves congruence in cross sectional patient courses. Our regional electronic medical record (EMR) integrates the shared medication record (SMR) which provides full access to current medication and medication prescriptions for all citizens in Denmark. We...

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

Science.gov (United States)

Carroll, Tracy; Tonges, Mary; Ray, Joel

2017-11-01

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

Help-seeking beliefs for mental disorders among medical and nursing students.

Science.gov (United States)

Picco, Louisa; Seow, Esmond; Chua, Boon Yiang; Mahendran, Rathi; Verma, Swapna; Xie, Huiting; Wang, Jia; Chong, Siow Ann; Subramaniam, Mythily

2018-05-09

The current study aimed to investigate beliefs about help-seeking, treatment options and expected outcomes for people with alcohol abuse, dementia, depression, obsessive-compulsive disorder and schizophrenia, using a vignette-based approach, among a sample of nursing and medical students. This was a cross-sectional online study among medical and nursing students (n = 1002) who were randomly assigned 1 of 5 vignettes. Questions were asked about whom could best help the person in the vignette, the likely helpfulness of a broad range of interventions, and the likely outcome for the person in the vignette with and without appropriate help. A total of 45.1% of students recommended seeing a psychiatrist, which was the most common source of help reported for all 5 vignettes. Help-seeking preferences were significantly associated with age, academic year and vignette type. Respondents rated seeing a psychiatrist as the most helpful intervention (92.4%) and dealing with the problem on their own as the most harmful (68.1%). Then, 81.5% of students indicated that the condition of the person in the vignette would worsen if appropriate help was not sought. Medical and nursing students most commonly recommended seeking help from a psychiatrist for mental health-related problems, where help-seeking preferences were associated with various age, academic year and vignette type. As these students will be the future medical and nursing workforce, they need to be equipped with the skills and ability to recognize signs and symptoms of mental illness, to aid timely and appropriate treatment for people with mental illness. © 2018 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd.

Technology Acceptance of Electronic Medical Records by Nurses

Science.gov (United States)

Stocker, Gary

2010-01-01

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

Towards iconic language for patient records, drug monographs, guidelines and medical search engines.

Science.gov (United States)

Lamy, Jean-Baptiste; Duclos, Catherine; Hamek, Saliha; Beuscart-Zéphir, Marie-Catherine; Kerdelhué, Gaetan; Darmoni, Stefan; Favre, Madeleine; Falcoff, Hector; Simon, Christian; Pereira, Suzanne; Serrot, Elisabeth; Mitouard, Thierry; Hardouin, Etienne; Kergosien, Yannick; Venot, Alain

2010-01-01

Practicing physicians have limited time for consulting medical knowledge and records. We have previously shown that using icons instead of text to present drug monographs may allow contraindications and adverse effects to be identified more rapidly and more accurately. These findings were based on the use of an iconic language designed for drug knowledge, providing icons for many medical concepts, including diseases, antecedents, drug classes and tests. In this paper, we describe a new project aimed at extending this iconic language, and exploring the possible applications of these icons in medicine. Based on evaluators' comments, focus groups of physicians and opinions of academic, industrial and associative partners, we propose iconic applications related to patient records, for example summarizing patient conditions, searching for specific clinical documents and helping to code structured data. Other applications involve the presentation of clinical practice guidelines and improving the interface of medical search engines. These new applications could use the same iconic language that was designed for drug knowledge, with a few additional items that respect the logic of the language.

Request for medical records or medical records in Brazil (Justice, Public Prosecution and Police x Medical Confidentiality

Directory of Open Access Journals (Sweden)

Roberta Fernandes Remédio Marques

2016-12-01

Full Text Available The request medical records for the instruction of criminal investigations, administrative and judicial proceedings is a reality in Brazil and arouses many questions. This article aims, in the light of the legislation and case law, bring some clarification on the subject, with no claim to exhaust it.

Implications of WWW technologies for exchanging medical records

Directory of Open Access Journals (Sweden)

Maurice Dixon

1999-09-01

Full Text Available This article addresses some of the implications for medical record exchange of very recent developments in technology and tools that support the World Wide Web. It argues that XML (Extensible Mark-up Language is a very good enabling technology for medical record exchange. XML provides a much cheaper way of executing the exchange of medical information that circumvents the need for proprietary software. Use of XML can also simplify solutions to the problems associated with coping with the evolution of medical systems in time. However XML on its own does not resolve all the semantic heterogeneities.

Medical Archive Recording System (MARS)

OpenAIRE

Mohammad Reza Tajvidi

2007-01-01

In this talk, one of the most efficient, and reliable integrated tools for CD/DVD production workflow, called Medical Archive Recording System (MARS) by ETIAM Company, France, which is a leader in multimedia connectivity for healthcare in Europe, is going to be introduced. "nThis tool is used to record all patient studies, route the studies to printers and PACS automatically, print key images and associated reports and log all study production for automated post processing/archiving. Its...

Evaluation of medical records maintenance quality in dental medical organizations of Kazan

Directory of Open Access Journals (Sweden)

A K Lapina

2018-02-01

Full Text Available Aim. Improvement of the quality control of dental medical organizations when diagnosing dentoalveolar anomalies and deformities. Methods. A retrospective analysis of an orthodontic patient’s medical record maintenance at the dental clinics of Kazan. Results. Only 30.7% of all the verified documentation were established to be most thoroughly and correctly filled. Information about the obligatory medical insurance policy was indicated only in 2 cards out of all the verified documentation. In all orthodontic patient medical records the fringe benefit category code was absent. The name of the insurance organization in which a patient was unsured, was available only in 2.3% of the cards. Patient’s passport data were available only in 14 (15.9% cards, and the type of payment for services was registered only in 38 (43.2%. The diagnosis established by a referring medical organization was indicated only in 7 (8% of the records. When examining the dental rows of patients, their dimensions and apical bases of the jaws, the shape of the dentition were indicated in 40.9% of the documentation. The contact of adjacent teeth was described in 36.4% of all cases, presence of diastema between the upper jaw incisors was represented in 30.7% of the medical charts of orthodontic patients. The diastema between the lower jaw incisors was reflected in 25 (28.4% medical charts of orthodontic patients. Based on the doctor’s notes in the medical records, it is difficult to understand whether the whole necessary list of diagnostic measures had been performed to the patient in order to confirm this or that orthodontic pathology. Such filling of the medical chart of orthodontic patient at times makes the experts doubt in the correctness of diagnosis of a certain patient. Conclusion. Doctors-orthodontists do not pay enough attention to the collection of anamnesis of the disease, evaluation of the nature of complaints, as well as use of basic and additional methods of

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

Science.gov (United States)

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

2016-01-01

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

Performance evaluation of medical records departments by analytical hierarchy process (AHP) approach in the selected hospitals in Isfahan : medical records dep. & AHP.

Science.gov (United States)

Ajami, Sima; Ketabi, Saeedeh

2012-06-01

Medical Records Department (MRD) is an important unit for evaluating and planning of care services. The goal of this study is evaluating the performance of the Medical Records Departments (MRDs) of the selected hospitals in Isfahan, Iran by using Analytical Hierarchy Process (AHP). This was an analytic of cross-sectional study that was done in spring 2008 in Isfahan, Iran. The statistical population consisted of MRDs of Alzahra, Kashani and Khorshid Hospitals in Isfahan. Data were collected by forms and through brainstorm technique. To analyze and perform AHP, Expert Choice software was used by researchers. Results were showed archiving unit has received the largest importance weight with respect to information management. However, on customer aspect admission unit has received the largest weight. Ordering weights of Medical Records Departments' Alzahra, Kashani and Khorshid Hospitals in Isfahan were with 0.394, 0.342 and 0.264 respectively. It is useful for managers to allocate and prioritize resources according to AHP technique for ranking at the Medical Records Departments.

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

Science.gov (United States)

Russell, Matthew

2011-09-01

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

The medical record entrepreneur: a future of opportunities.

Science.gov (United States)

Dietz, M S; Nath, D D

1989-06-01

In summary, medical record practitioners can become successful entrepreneurs with the right motivation. It will be important to overcome the fear and inertia inherent in any bold new venture, to find our "niche," to assume the roles of explorer, artist, judge, and champion, as well as to encourage and promote our development within an organization or in a business of our own. Medical record entrepreneurs need to evaluate and understand current and potential consumers, their current needs, perceptions, and future needs. Entrepreneurs should capitalize on strengths, develop innovative marketing approaches, and apply them. In the current climate of the health care industry, there is a myriad of entrepreneurial opportunities available to the medical record profession. It all begins with the individual.

Mythbusting Medical Writing: Goodbye, Ghosts! Hello, Help!

Science.gov (United States)

Hamilton, Cindy W; Gertel, Art; Jacobs, Adam; Marchington, Jackie; Weaver, Shelley; Woolley, Karen

To meet ethical and scientific obligations, authors should submit timely, high-quality manuscripts. Authors, however, can encounter ethical (e.g., authorship designation) and practical (e.g., time and resource limitations) challenges during manuscript preparation. Could professional medical writers-not ghostwriters-help authors address these challenges? This essay summarizes evidence countering three myths that may have hindered authors from considering the use of professional medical writers. Authors with sufficient time, writing expertise, and reporting guideline knowledge may meet their obligations without writing assistance. Unfortunately, not all authors are in this position. Decisions about writing support should be based on evidence, not myths.

42 CFR 416.47 - Condition for coverage-Medical records.

Science.gov (United States)

2010-10-01

... accurate medical records to ensure adequate patient care. (a) Standard: Organization. The ASC must develop and maintain a system for the proper collection, storage, and use of patient records. (b) Standard...) Patient identification. (2) Significant medical history and results of physical examination. (3) Pre...

Medical Records and Correspondence Demand Respect

Directory of Open Access Journals (Sweden)

M Benamer

2007-01-01

there is to know or has every diagnostic tool available. I understand from speaking to doctors who practice in Libya that medical documentation is rudimentary. If it exists, it lacks clarity, continuity, confidentiality, and accountability. Doctors fail to sign and date their orders if they enter them in patients’ notes [2]. Relaying patients’ information to colleagues is mainly done verbally without much documentation [3]. People who need to go abroad for governmental paid treatment may request a medical report. These are almost always simple, short letters without clear diagnoses, treatment recommendations, or a current medication list. I recall senior surgeons who left the duty of writing the operative notes to the most junior doctor on the team. There is a lesson to be learnt here from other physicians who demand more of themselves and of their colleagues, as it helps advance practice There might be few potential reasons to explain why this malpractice is happening:1. Concern about litigation.2. Lack of basic clerical support.3. Lack of appropriate stationary or reliable postal service4. No clear guidelines from the relevant governing body 5. Lack of confidence6. Lack of a general practitioner to look after the patient’s interest With widespread communication technology, there is no excuse for doctors today to fail to document patient information. Computer software provides a simple method for documentation and allows for the swift electronic transmission of data to and from colleagues. We are more prone to litigation if we fail to record what we have done with our patients. We may forget the old adage “if it’s not documented, it was not done.” This is how attorneys approach medical documentation when retained for legal services. It is important we do not forget this simple fact. I was unable to find any clear guidelines from the medical board in Libya about keeping case notes and writing correspondence, although these guidelines are widely available

Implementation of a Big Data Accessing and Processing Platform for Medical Records in Cloud.

Science.gov (United States)

Yang, Chao-Tung; Liu, Jung-Chun; Chen, Shuo-Tsung; Lu, Hsin-Wen

2017-08-18

Big Data analysis has become a key factor of being innovative and competitive. Along with population growth worldwide and the trend aging of population in developed countries, the rate of the national medical care usage has been increasing. Due to the fact that individual medical data are usually scattered in different institutions and their data formats are varied, to integrate those data that continue increasing is challenging. In order to have scalable load capacity for these data platforms, we must build them in good platform architecture. Some issues must be considered in order to use the cloud computing to quickly integrate big medical data into database for easy analyzing, searching, and filtering big data to obtain valuable information.This work builds a cloud storage system with HBase of Hadoop for storing and analyzing big data of medical records and improves the performance of importing data into database. The data of medical records are stored in HBase database platform for big data analysis. This system performs distributed computing on medical records data processing through Hadoop MapReduce programming, and to provide functions, including keyword search, data filtering, and basic statistics for HBase database. This system uses the Put with the single-threaded method and the CompleteBulkload mechanism to import medical data. From the experimental results, we find that when the file size is less than 300MB, the Put with single-threaded method is used and when the file size is larger than 300MB, the CompleteBulkload mechanism is used to improve the performance of data import into database. This system provides a web interface that allows users to search data, filter out meaningful information through the web, and analyze and convert data in suitable forms that will be helpful for medical staff and institutions.

AVAILABILITY, ACCESSIBILITY, PRIVACY AND SAFETY ISSUES FACING ELECTRONIC MEDICAL RECORDS

OpenAIRE

Nisreen Innab

2018-01-01

Patient information recorded in electronic medical records is the most significant set of information of the healthcare system. It assists healthcare providers to introduce high quality care for patients. The aim of this study identifies the security threats associated with electronic medical records and gives recommendations to keep them more secured. The study applied the qualitative research method through a case study. The study conducted seven interviews with medical staff and informatio...

Ethnicity Recording in Primary Care Computerised Medical Record Systems: An Ontological Approach

Directory of Open Access Journals (Sweden)

Zayd Tippu

2017-03-01

Full Text Available Background Ethnicity recording within primary care computerised medical record (CMR systems is suboptimal, exacerbated by tangled taxonomies within current coding systems. Objective To develop a method for extending ethnicity identification using routinely collected data. Methods We used an ontological method to maximise the reliability and prevalence of ethnicity information in the Royal College of General Practitioner’s Research and Surveillance database. Clinical codes were either directly mapped to ethnicity group or utilised as proxy markers (such as language spoken from which ethnicity could be inferred. We compared the performance of our method with the recording rates that would be identified by code lists utilised by the UK pay for the performance system, with the help of the Quality and Outcomes Framework (QOF. Results Data from 2,059,453 patients across 110 practices were included. The overall categorisable ethnicity using QOF codes was 36.26% (95% confidence interval (CI: 36.20%–36.33%. This rose to 48.57% (CI:48.50%–48.64% using the described ethnicity mapping process. Mapping increased across all ethnic groups. The largest increase was seen in the white ethnicity category (30.61%; CI: 30.55%–30.67% to 40.24%; CI: 40.17%–40.30%. The highest relative increase was in the ethnic group categorised as the other (0.04%; CI: 0.03%–0.04% to 0.92%; CI: 0.91%–0.93%. Conclusions This mapping method substantially increases the prevalence of known ethnicity in CMR data and may aid future epidemiological research based on routine data.

Patients prefer electronic medical records - fact or fiction?

Science.gov (United States)

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

2013-01-01

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

How patients can improve the accuracy of their medical records.

Science.gov (United States)

Dullabh, Prashila M; Sondheimer, Norman K; Katsh, Ethan; Evans, Michael A

2014-01-01

Assess (1) if patients can improve their medical records' accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback's impact on medical record accuracy. Improving medical record' accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records' accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists' accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists' medication reconciliation logs. (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency-or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms, pharmacists responded positively to 68 percent of patient requests for

Visual patient records

NARCIS (Netherlands)

Luu, M.D.

2015-01-01

Patient information is often complex and fragmented; visualization can help to obtain and communicate insights. To move from paper medical records to interactive and visual patient records is a big challenge. This project aims to move towards this ultimate goal by providing an interactive prototype

Medical Record Clerk Training Program, Course of Study; Student Manual: For Medical Record Personnel in Small Rural Hospitals in Colorado.

Science.gov (United States)

Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.

The manual provides major topics, objectives, activities and, procedures, references and materials, and assignments for the training program. The topics covered are hospital organization and community role, organization and management of a medical records department, international classification of diseases and operations, medical terminology,…

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

Science.gov (United States)

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.

Updated posters to help manage medical emergencies in the dental practice.

Science.gov (United States)

Jevon, P

2015-09-11

Medical emergencies can occur in the dental practice. Medical Emergencies in the Dental Practice and Emergency Drugs in the Dental Practice posters have been designed to help dental practitioners to respond effectively and safely to a medical emergency. These posters, endorsed by the British Dental Association, are included with this issue of the British Dental Journal. Further copies can be downloaded from: https://www.walsallhealthcare.nhs.uk/medical-education.aspx.

Implementation of an Electronic Medical Records System

National Research Council Canada - National Science Library

Fletcher, Chadwick B

2008-01-01

.... Substantial benefits are realized through routine use of electronic medical records include improved quality, safety, and efficiency, along with the increased ability to conduct education and research...

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

Roles of Medical Record and Statistic Staff on Research at the Tawanchai Center.

Science.gov (United States)

Pattaranit, Rumpan; Chantachum, Vasana; Lekboonyasin, Orathai; Pradubwong, Suteera

2015-08-01

The medical record and statistic staffs play a crucial role behind the achievements of treatment and research of physicians, nurses and other health care professionals. The medical record and statistic staff are in charge of keeping patient medical records; creating databases; presenting information; sorting patient's information; providing patient medical records and related information for various medical teams and researchers; Besides, the medical record and statistic staff have collaboration with the Center of Cleft Lip-Palate, Khon Kaen University in association with the Tawanchai Project. The Tawanchai Center is an organization, involving multidisciplinary team which aims to continuing provide care for patients with cleft lip and palate and craniofacial deformities who need a long term of treatment since newborns until the age of 19 years. With support and encouragement from the Tawanchai team, the medical record and statistic staff have involved in research under the Tawanchai Centre since then and produced a number of publications locally and internationally.

Admission medical records made at night time have the same quality as day and evening time records

DEFF Research Database (Denmark)

Amirian, Ilda; Mortensen, Jacob F; Rosenberg, Jacob

2014-01-01

INTRODUCTION: A thorough and accurate admission medical record is an important tool in ensuring patient safety during the hospital stay. Surgeons' performance might be affected during night shifts due to sleep deprivation. The aim of the study was to assess the quality of admission medical records...

Medical record management systems: criticisms and new perspectives.

Science.gov (United States)

Frénot, S; Laforest, F

1999-06-01

The first generation of computerized medical records stored the data as text, but these records did not bring any improvement in information manipulation. The use of a relational database management system (DBMS) has largely solved this problem as it allows for data requests by using SQL. However, this requires data structuring which is not very appropriate to medicine. Moreover, the use of templates and icon user interfaces has introduced a deviation from the paper-based record (still existing). The arrival of hypertext user interfaces has proven to be of interest to fill the gap between the paper-based medical record and its electronic version. We think that further improvement can be accomplished by using a fully document-based system. We present the architecture, advantages and disadvantages of classical DBMS-based and Web/DBMS-based solutions. We also present a document-based solution and explain its advantages, which include communication, security, flexibility and genericity.

Automated de-identification of free-text medical records

Directory of Open Access Journals (Sweden)

Long William J

2008-07-01

Full Text Available Abstract Background Text-based patient medical records are a vital resource in medical research. In order to preserve patient confidentiality, however, the U.S. Health Insurance Portability and Accountability Act (HIPAA requires that protected health information (PHI be removed from medical records before they can be disseminated. Manual de-identification of large medical record databases is prohibitively expensive, time-consuming and prone to error, necessitating automatic methods for large-scale, automated de-identification. Methods We describe an automated Perl-based de-identification software package that is generally usable on most free-text medical records, e.g., nursing notes, discharge summaries, X-ray reports, etc. The software uses lexical look-up tables, regular expressions, and simple heuristics to locate both HIPAA PHI, and an extended PHI set that includes doctors' names and years of dates. To develop the de-identification approach, we assembled a gold standard corpus of re-identified nursing notes with real PHI replaced by realistic surrogate information. This corpus consists of 2,434 nursing notes containing 334,000 words and a total of 1,779 instances of PHI taken from 163 randomly selected patient records. This gold standard corpus was used to refine the algorithm and measure its sensitivity. To test the algorithm on data not used in its development, we constructed a second test corpus of 1,836 nursing notes containing 296,400 words. The algorithm's false negative rate was evaluated using this test corpus. Results Performance evaluation of the de-identification software on the development corpus yielded an overall recall of 0.967, precision value of 0.749, and fallout value of approximately 0.002. On the test corpus, a total of 90 instances of false negatives were found, or 27 per 100,000 word count, with an estimated recall of 0.943. Only one full date and one age over 89 were missed. No patient names were missed in either

Factors Related to Abstinence from Drug Use and Seeking Help from Medical Services in Taiwanese Heroin and Methamphetamine Users

Directory of Open Access Journals (Sweden)

Chia-Nan Yen

2008-02-01

Full Text Available The aim of this study was to examine the factors related to abstinence from heroin and methamphetamine (MAMP use and to seeking help from medical services in Taiwanese drug users. Atotal of 196 heroin users and 226 MAMP users were recruited in this study. Their experience of previous abstinence from drug use and the routes taken to seek help for abstinence were determined at interview. Demographic data, characteristics of drug use and reasons to abstain from drug use were compared between subjects who had and those who had never tried to abstain from drug use before, as well as between the subjects who had previously sought help from medical services and those who had tried to abstain from drug use by themselves. Those who had previously tried to abstain from heroin use had longer durations of heroin use, spent more money on getting heroin, were more likely to have a criminal record of illicit drug use and had longer durations of being detained due to illicit drug use compared with those who had never tried to abstain from heroin use. Those who had sought help from medical services for abstinence were more likely to be heroin users and to spend more money on getting illicit drugs, and tried to abstain due to concerns about relationships with family. Demographic data, characteristics of drug use and reasons to abstain from drug use were different between drug users who had different experiences of abstinence.

Privacy Impact Assessment for the Wellness Program Medical Records

Science.gov (United States)

The Wellness Program Medical Records System collects contact information and other Personally Identifiable Information (PII). Learn how this data is collected, used, accessed, the purpose of data collection, and record retention policies.

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

Directory of Open Access Journals (Sweden)

Simon Steven R

2002-12-01

Full Text Available Abstract Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Methods We reviewed electronic medical records from 834 patients receiving care from 167 physicians (117 internists and 50 pediatricians at 14 sites of a multi-specialty medical group in Massachusetts. We abstracted information for five measures of medical record documentation quality: smoking history, medications, drug allergies, compliance with screening guidelines, and immunizations. From other sources we determined physicians' specialty, gender, year of medical school graduation, and self-reported time spent teaching and in patient care. Results Among internists, unadjusted rates of documentation were 96.2% for immunizations, 91.6% for medications, 88% for compliance with screening guidelines, 61.6% for drug allergies, 37.8% for smoking history. Among pediatricians, rates were 100% for immunizations, 84.8% for medications, 90.8% for compliance with screening guidelines, 50.4% for drug allergies, and 20.4% for smoking history. While certain physician and patient characteristics correlated with some measures of documentation quality, documentation varied depending on the measure. For example, female internists were more likely than male internists to document smoking history (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.27 – 2.83 but were less likely to document drug allergies (OR, 0.51; 95% CI, 0.35 – 0.75. Conclusions Medical record documentation varied depending on the measure, with room for improvement in most domains. A variety of

Characteristics of registration of medical records in a hospital in southern Peru

Directory of Open Access Journals (Sweden)

Cender Udai Quispe-Juli

2016-04-01

Full Text Available Objective: To determine the characteristics of registration of medical records of hospitalization in the Hospital III Yanahuara in Arequipa, Peru. Material and methods: The study was observational, cross-sectional and retrospective. 225 medical records of hospitalization were evaluated in November 2015. A tab consisting of 15 items was used; each item was assessed using a scale: "very bad", "bad", "acceptable", "good" and "very good". Adescriptive analysis was done by calculating frequency. Results: Items with a higher proportion of acceptable registration data were: clear therapeutic indication (84%, clinical evolution (74.7%, diagnosis (70.7%, complete and orderly therapeutic indication (54.2%, medical history taking (50.2% and physical examination (43.1%. The very well recorded items were: indication of tests and procedures (97.3%, medical identification (91.1% and allergies (67.1%. Very bad recorded items were: reason for admission (91.1%, life habits (72.9% and prior treatment (38.2%. Conclusions: Most medical records of hospitalization are characterized by an acceptable record of most evaluated items; however they have notable deficiencies in some items.

Medical Help-Seeking for Sexual Concerns in Prostate Cancer Survivors

Science.gov (United States)

Hyde, Melissa K.; Zajdlewicz, Leah; Wootten, Addie C.; Nelson, Christian J.; Lowe, Anthony; Dunn, Jeff; Chambers, Suzanne K.

2016-01-01

Introduction Although sexual dysfunction is common after prostate cancer, men's decisions to seek help for sexual concerns are not well understood. Aim Describe predictors of actual prior help-seeking and intended future medical help-seeking for sexual dysfunction in prostate cancer survivors. Methods A cross-sectional survey of 510 prostate cancer survivors assessed masculine beliefs, attitudes, support/approval from partner/peer networks (subjective norm), and perceived control as predictors of medical help-seeking for sexual concerns. A theory of planned behavior (TPB) perspective was used to examine actual prior and planned future behavior and contributing factors. Statistical analyses included multiple and logistic regressions. Main Outcome Measures Intention to see a doctor for sexual advice or help in the next 6 months was measured using the intention subscale adapted from the Attitudes to Seeking Help after Cancer Scale. Prior help-seeking was measured with a dichotomous yes/no scale created for the study. Results Men were Mage 71.69 years (SD = 7.71); 7.54 years (SD = 4.68) post-diagnosis; received treatment(s) (58.1% radical prostatectomy; 47.1% radiation therapy; 29.4% hormonal ablation); 81.4% reported severe ED (IIED 0–6) and 18.6% moderate–mild ED (IIED 7–24). Overall, 30% had sought sexual help in the past 6 months, and 24% intended to seek help in the following 6 months. Prior help-seeking was less frequent among men with severe ED. Sexual help-seeking intentions were associated with lower education, prior sexual help-seeking, sexual importance/ priority, emotional self-reliance, positive attitude, and subjective norm (R2 = 0.56). Conclusion The TPB has utility as a theoretical framework to understand prostate cancer survivors' sexual help-seeking decisions and may inform development of more effective interventions. Masculine beliefs were highly salient. Men who were more emotionally self-reliant and attributed greater importance to sex

Patient-centred care: using online personal medical records in IVF practice.

NARCIS (Netherlands)

Tuil, W.S.; Hoopen, A.J. ten; Braat, D.D.M.; Vries Robbé, P.F. de; Kremer, J.A.M.

2006-01-01

BACKGROUND: Generic patient-accessible medical records have shown promise in enhancing patient-centred care for patients with chronic diseases. We sought to design, implement and evaluate a patient-accessible medical record specifically for patients undergoing a course of assisted reproduction (IVF

Partnered Decisions? U.S. Couples and Medical Help-Seeking for Infertility

Science.gov (United States)

Johnson, Katherine M.; Johnson, David R.

2009-01-01

We examined male partners' influence on the decision to seek medical help for infertility using the National Study of Fertility Barriers. Building upon an existing help-seeking framework, we incorporated characteristics of both partners from 219 heterosexual couples who had ever perceived a fertility problem. In logistic regression analyses, we…

Clinical audit teaching in record-keeping for dental undergraduates at International Medical University, Kuala Lumpur, Malaysia.

Science.gov (United States)

Chong, Jun A; Chew, Jamie K Y; Ravindranath, Sneha; Pau, Allan

2014-02-01

This study investigated the impact of clinical audit training on record-keeping behavior of dental students and students' perceptions of the clinical audit training. The training was delivered to Year 4 and Year 5 undergraduates at the School of Dentistry, International Medical University, Kuala Lumpur, Malaysia. It included a practical audit exercise on patient records. The results were presented by the undergraduates, and guidelines were framed from the recommendations proposed. Following this, an audit of Year 4 and Year 5 students' patient records before and after the audit training was carried out. A total of 100 records were audited against a predetermined set of criteria by two examiners. An email survey of the students was also conducted to explore their views of the audit training. Results showed statistically significant improvements in record-keeping following audit training. Responses to the email survey were analyzed qualitatively. Respondents reported that the audit training helped them to identify deficiencies in their record-keeping practice, increased their knowledge in record-keeping, and improved their record-keeping skills. Improvements in clinical audit teaching were also proposed.

Corridor consultations and the medical microbiological record: is patient safety at risk?

Science.gov (United States)

Heard, S R; Roberts, C; Furrows, S J; Kelsey, M; Southgate, L

2003-01-01

The performance procedures of the General Medical Council are aimed at identifying seriously deficient performance in a doctor. The performance procedures require the medical record to be of a standard that enables the next doctor seeing the patient to give adequate care based on the available information. Setting standards for microbiological record keeping has proved difficult. Over one fifth of practising medical microbiologists (including virologists) in the UK (139 of 676) responded to a survey undertaken by the working group developing the performance procedures for microbiology, to identify current practice and to develop recommendations for agreement within the profession about the standards of the microbiological record. The cumulative frequency for the surveyed recording methods used indicated that at various times 65% (90 of 139) of respondents used a daybook, 62% (86 of 139) used the back of the clinical request card, 57% (79 of 139) used a computer record, and 22% (30 of 139) used an index card system to record microbiological advice, suggesting wide variability in relation to how medical microbiologists maintain clinical records. PMID:12499432

A cloud-based framework for large-scale traditional Chinese medical record retrieval.

Science.gov (United States)

Liu, Lijun; Liu, Li; Fu, Xiaodong; Huang, Qingsong; Zhang, Xianwen; Zhang, Yin

2018-01-01

Electronic medical records are increasingly common in medical practice. The secondary use of medical records has become increasingly important. It relies on the ability to retrieve the complete information about desired patient populations. How to effectively and accurately retrieve relevant medical records from large- scale medical big data is becoming a big challenge. Therefore, we propose an efficient and robust framework based on cloud for large-scale Traditional Chinese Medical Records (TCMRs) retrieval. We propose a parallel index building method and build a distributed search cluster, the former is used to improve the performance of index building, and the latter is used to provide high concurrent online TCMRs retrieval. Then, a real-time multi-indexing model is proposed to ensure the latest relevant TCMRs are indexed and retrieved in real-time, and a semantics-based query expansion method and a multi- factor ranking model are proposed to improve retrieval quality. Third, we implement a template-based visualization method for displaying medical reports. The proposed parallel indexing method and distributed search cluster can improve the performance of index building and provide high concurrent online TCMRs retrieval. The multi-indexing model can ensure the latest relevant TCMRs are indexed and retrieved in real-time. The semantics expansion method and the multi-factor ranking model can enhance retrieval quality. The template-based visualization method can enhance the availability and universality, where the medical reports are displayed via friendly web interface. In conclusion, compared with the current medical record retrieval systems, our system provides some advantages that are useful in improving the secondary use of large-scale traditional Chinese medical records in cloud environment. The proposed system is more easily integrated with existing clinical systems and be used in various scenarios. Copyright © 2017. Published by Elsevier Inc.

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

Science.gov (United States)

Gardner, Carrie Lee; Pearce, Patricia F

2013-03-01

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

Medical impacts of anthropometric records. | Adebisi | Annals of ...

African Journals Online (AJOL)

Anthropology is now one of the inter-disciplinary scientific fields that is gaining much attention in forensic, socio-cultural, industrial and bio-medical applications. There is a need for a better awareness of some of the impacts - past and present, in the medical practice, of the records that were obtained by workers in this field in ...

A computerised out-patient medical records programme based on the Summary Time-Oriented Record (STOR) System.

Science.gov (United States)

Cheong, P Y; Goh, L G; Ong, R; Wong, P K

1992-12-01

Advances in microcomputer hardware and software technology have made computerised outpatient medical records practical. We have developed a programme based on the Summary Time-Oriented Record (STOR) system which complements existing paper-based record keeping. The elements of the Problem Oriented Medical Record (POMR) System are displayed in two windows within one screen, namely, the SOAP (Subjective information, Objective information, Assessments and Plans) elements in the Reason For Encounter (RFE) window and the problem list with outcomes in the Problem List (PL) window. Context sensitive child windows display details of plans of management in the RFE window and clinical notes in the PL window. The benefits of such innovations to clinical decision making and practice based research and its medico-legal implications are discussed.

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

Science.gov (United States)

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

2012-08-01

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

NEED ANALYSIS FOR IDENTIFYING ESP MATERIALS FOR MEDICAL RECORD STUDENTS IN APIKES CITRA MEDIKA SURAKARTA

Directory of Open Access Journals (Sweden)

Beta Setiawati

2016-06-01

and quantitative methods. The outcomesof this study showed the real necessities of students in learning English to prepare their future at the field of medical record and health information. Findings of the need analysis demonstrate that all four of the language skills were necessary for their academic studies and their target career. There are certain topics related to English for medical record such as medical record staff’ duties, ethical and legal issues in medical record, Hospital statistics, Medical record filling system, Health information system, and so on. Accordingly, this study proposes new ESP materials based on the stakeholders’ needs.It is suggested that textbook or handout of English for Medical Record will be made based on the Need Analysis by ESP designers and ESP lecturers involve actively recognizing the progressive needs of medical record students.

A method for creating teaching movie clips using screen recording software: usefulness of teaching movies as self-learning tools for medical students

Energy Technology Data Exchange (ETDEWEB)

Hwang, Seong Su [The Catholic University of Korea, Suwon (Korea, Republic of)

2007-04-15

I wanted to describe a method to create teaching movies with using screen recordings, and I wanted to see if self-learning movies are useful for medical students. Teaching movies were created by direct recording of the screen activity and voice narration during the interpretation of educational cases; we used a PACS system and screen recording software for the recording (CamStudio, Rendersoft, U.S.A.). The usefulness of teaching movies for seft-learning of abdominal CT anatomy was evacuated by the medical students. Creating teaching movie clips with using screen recording software was simple and easy. Survey responses were collected from 43 medical students. The contents of teaching movie was adequately understandable (52%) and useful for learning (47%). Only 23% students agreed the these movies helped motivated them to learn. Teaching movies were more useful than still photographs of the teaching image files. The students wanted teaching movies on the cross-sectional CT anatomy of different body regions (82%) and for understanding the radiological interpretation of various diseases (42%). Creating teaching movie by direct screen recording of a radiologist's interpretation process is easy and simple. The teaching video clips reveal a radiologist's interpretation process or the explanation of teaching cases with his/her own voice narration, and it is an effective self-learning tool for medical students and residents.

A method for creating teaching movie clips using screen recording software: usefulness of teaching movies as self-learning tools for medical students

International Nuclear Information System (INIS)

Hwang, Seong Su

2007-01-01

I wanted to describe a method to create teaching movies with using screen recordings, and I wanted to see if self-learning movies are useful for medical students. Teaching movies were created by direct recording of the screen activity and voice narration during the interpretation of educational cases; we used a PACS system and screen recording software for the recording (CamStudio, Rendersoft, U.S.A.). The usefulness of teaching movies for seft-learning of abdominal CT anatomy was evacuated by the medical students. Creating teaching movie clips with using screen recording software was simple and easy. Survey responses were collected from 43 medical students. The contents of teaching movie was adequately understandable (52%) and useful for learning (47%). Only 23% students agreed the these movies helped motivated them to learn. Teaching movies were more useful than still photographs of the teaching image files. The students wanted teaching movies on the cross-sectional CT anatomy of different body regions (82%) and for understanding the radiological interpretation of various diseases (42%). Creating teaching movie by direct screen recording of a radiologist's interpretation process is easy and simple. The teaching video clips reveal a radiologist's interpretation process or the explanation of teaching cases with his/her own voice narration, and it is an effective self-learning tool for medical students and residents

Genetic databases and consent for use of medical records

NARCIS (Netherlands)

Gevers, J. K. M.

2004-01-01

The legislation on the Icelandic genetic database provides for an opting-out system for the collection of encoded medical information from individual medical records. From the beginning this has raised criticism, in Iceland itself and abroad. The Supreme Court has now decided that this approach of

A review of electronic medical record keeping on mobile medical service trips in austere settings.

Science.gov (United States)

Dainton, Christopher; Chu, Charlene H

2017-02-01

helpful given the environment and low resource context. Results from this review may be useful to non-government organizations (NGOs) considering modernization of their medical records practices as EMR use facilitates research, decreases paper administration costs, and improves perceptions of professionalism; however, most MST-specific EMRs remain in their early stages, and further development and research is required before reaching the stage of widespread adoption. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Predicting healthcare trajectories from medical records: A deep learning approach.

Science.gov (United States)

Pham, Trang; Tran, Truyen; Phung, Dinh; Venkatesh, Svetha

2017-05-01

Personalized predictive medicine necessitates the modeling of patient illness and care processes, which inherently have long-term temporal dependencies. Healthcare observations, stored in electronic medical records are episodic and irregular in time. We introduce DeepCare, an end-to-end deep dynamic neural network that reads medical records, stores previous illness history, infers current illness states and predicts future medical outcomes. At the data level, DeepCare represents care episodes as vectors and models patient health state trajectories by the memory of historical records. Built on Long Short-Term Memory (LSTM), DeepCare introduces methods to handle irregularly timed events by moderating the forgetting and consolidation of memory. DeepCare also explicitly models medical interventions that change the course of illness and shape future medical risk. Moving up to the health state level, historical and present health states are then aggregated through multiscale temporal pooling, before passing through a neural network that estimates future outcomes. We demonstrate the efficacy of DeepCare for disease progression modeling, intervention recommendation, and future risk prediction. On two important cohorts with heavy social and economic burden - diabetes and mental health - the results show improved prediction accuracy. Copyright © 2017 Elsevier Inc. All rights reserved.

Mental health self-care in medical students: a comprehensive look at help-seeking.

Science.gov (United States)

Gold, Jessica A; Johnson, Benjamin; Leydon, Gary; Rohrbaugh, Robert M; Wilkins, Kirsten M

2015-02-01

The authors characterize medical student help-seeking behaviors and examine the relationship with stress, burnout, stigma, depression, and personal health behaviors. In 2013, the authors administered an electronic survey of all enrolled students at Yale School of Medicine (183 responders, response rate=35 %), inquiring about students' primary medical and mental health care, personal health behaviors, support systems, and help-seeking behaviors. Students completed the Attitudes to Mental Health Questionnaire, the Patient Health Questionnaire-2, and a modified Maslach Burnout Inventory. The authors analyzed the results with logistic regression, the Wilcoxon rank-sum test, the Kruskal-Wallis test, or a test for significance of Kendall rank correlation. Most students reported having a primary care provider (PCP), yet few reported seeking care when sick (33 %). Nineteen percent of students reported having a mental health provider, fewer than reported having a PCP (pstudents reported increased mental health needs since beginning medical school, and these students were more likely to agree that their needs were untreated. The majority of students endorsed stress, which correlated with increased and unmet mental health needs (pstudents and correlated with stress and increased and untreated needs. Most students reported comfort with asking for academic help; those uncomfortable were more likely to have mental health needs for which they did not seek treatment (p=0.004). Mental health stigma was low. Medical students had a significant unmet need for health care, influenced by barriers to accessing care, stress, burnout, and depression. Academic help seeking and supportive faculty relationships appear related to mental health treatment seeking. Targeted interventions for stress and burnout reduction, as well as incorporation of reflective practice, may have an impact on overall care seeking among medical students. Future studies should expand to other medical and professional

[The global medical record + (DMG+), tool for prevention in first line care].

Science.gov (United States)

Schetgen, M

2012-09-01

The "global medical record +" can be offered to all 45 to 75 year-old patients in the form of a prevention module within the global medical record and which the general practitioner and the patient will regularly update. It will include in particular an assessment of cardiovascular risk, cervical, breast and colon cancer screening, a check of main adult vaccinations, as well as a primary prevention section focused on smoking, alcohol consumption and various hygiene and dietary measures. The inclusion of this module in a computerized medical record will make it more efficient and will lighten the practitioner's workload.

Data-driven approach for creating synthetic electronic medical records

Directory of Open Access Journals (Sweden)

Moniz Linda

2010-10-01

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

Data-driven approach for creating synthetic electronic medical records.

Science.gov (United States)

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

2010-10-14

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

Evaluation of Randomly Selected Completed Medical Records Sheets in Teaching Hospitals of Jahrom University of Medical Sciences, 2009

Directory of Open Access Journals (Sweden)

Mohammad Parsa Mahjob

2011-06-01

Full Text Available Background and objective: Medical record documentation, often use to protect the patients legal rights, also providing information for medical researchers, general studies, education of health care staff and qualitative surveys is used. There is a need to control the amount of data entered in the medical record sheets of patients, considering the completion of these sheets is often carried out after completion of service delivery to the patients. Therefore, in this study the prevalence of completeness of medical history, operation reports, and physician order sheets by different documentaries in Jahrom teaching hospitals during year 2009 was analyzed. Methods and Materials: In this descriptive / retrospective study, the 400 medical record sheets of the patients from two teaching hospitals affiliated to Jahrom medical university was randomly selected. The tool of data collection was a checklist based on the content of medical history sheet, operation report and physician order sheets. The data were analyzed by SPSS (Version10 software and Microsoft Office Excel 2003. Results: Average of personal (Demography data entered in medical history, physician order and operation report sheets which is done by department's secretaries were 32.9, 35.8 and 40.18 percent. Average of clinical data entered by physician in medical history sheet is 38 percent. Surgical data entered by the surgeon in operation report sheet was 94.77 percent. Average of data entered by operation room's nurse in operation report sheet was 36.78 percent; Average of physician order data in physician order sheet entered by physician was 99.3 percent. Conclusion: According to this study, the rate of completed record papers reviewed by documentary in Jahrom teaching hospitals were not desirable and in some cases were very weak and incomplete. This deficiency was due to different reason such as medical record documentaries negligence, lack of adequate education for documentaries, High work

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

Science.gov (United States)

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

2017-03-01

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

The Next Generation Precision Medical Record - A Framework for Integrating Genomes and Wearable Sensors with Medical Records

OpenAIRE

Batra, Prag; Singh, Enakshi; Bog, Anja; Wright, Mark; Ashley, Euan; Waggott, Daryl

2016-01-01

Current medical records are rigid with regards to emerging big biomedical data. Examples of poorly integrated big data that already exist in clinical practice include whole genome sequencing and wearable sensors for real time monitoring. Genome sequencing enables conventional diagnostic interrogation and forms the fundamental baseline for precision health throughout a patients lifetime. Mobile sensors enable tailored monitoring regimes for both reducing risk through precision health intervent...

An inventory of publications on electronic medical records revisited.

Science.gov (United States)

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

2009-01-01

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

Learning a Health Knowledge Graph from Electronic Medical Records.

Science.gov (United States)

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

2017-07-20

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

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

Science.gov (United States)

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

2018-04-20

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

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

Grandinetti, D A

2000-03-06

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

Oncofertility: A New Medical Specialty Helping Young Cancer Patients Have Children

Science.gov (United States)

... Oncofertility: A New Medical Specialty Helping Young Cancer Patients Have Children Past Issues / Fall 2014 Table of ... old problem: the fertility needs of young cancer patients. The word itself was coined through NIH-sponsored ...

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

Science.gov (United States)

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

2017-12-24

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

Building clinical data groups for electronic medical record in China.

Science.gov (United States)

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

2012-04-01

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

Perspectives for medical informatics. Reusing the electronic medical record for clinical research.

Science.gov (United States)

Prokosch, H U; Ganslandt, T

2009-01-01

Even though today most university hospitals have already implemented commercial hospital information systems and started to build up comprehensive electronic medical records, reuse of such data for data warehousing and research purposes is still very rare. Given this situation, the focus of this paper is to present an overview on exemplary projects, which have already tackled this challenge, reflect on current initiatives within the United States of America and the European Union to establish IT infrastructures for clinical and translational research, and draw attention to new challenges in this area. This paper does not intend to provide a fully comprehensive review on all the issues of clinical routine data reuse. It is based, however, on a presentation of a large variety of historical, but also most recent activities in data warehousing, data retrieval and linking medical informatics with translational research. The article presents an overview of the various international approaches to this issue and illustrates concepts and solutions which have been published, thus giving an impression of activities pursued in this field of medical informatics. Further, problems and open questions, which have also been named in the literature, are presented and three challenges (to establish comprehensive clinical data warehouses, to establish professional IT infrastructure applications supporting clinical trial data capture and to integrate medical record systems and clinical trial databases) related to this area of medical informatics are identified and presented. Translational biomedical research with the aim "to integrate bedside and biology" and to bridge the gap between clinical care and medical research today and in the years to come, provides a large and interesting field for medical informatics researchers. Especially the need for integrating clinical research projects with data repositories built up during documentation of routine clinical care, today still leaves

Medical record automation at the Los Alamos Scientific Laboratory

International Nuclear Information System (INIS)

Hogle, G.O.; Grier, R.S.

1979-01-01

With the increase in population at the Los Alamos Scientific Laboratory and the growing concern over employee health, especially concerning the effects of the work environment, the Occupational Medicine Group decided to automate its medical record keeping system to meet these growing demands. With this computer system came not only the ability for long-term study of the work environment verses employee health, but other benefits such as more comprehensive records, increased legibility, reduced physician time, and better records management

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

Science.gov (United States)

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

2018-06-05

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

The concordance between self-reported medication use and pharmacy records in pregnant women.

Science.gov (United States)

Cheung, K; El Marroun, H; Elfrink, M E; Jaddoe, V W V; Visser, L E; Stricker, B H Ch

2017-09-01

Several studies have been conducted to assess determinants affecting the performance or accuracy of self-reports. These studies are often not focused on pregnant women, or medical records were used as a data source where it is unclear if medications have been dispensed. Therefore, our objective was to evaluate the concordance between self-reported medication data and pharmacy records among pregnant women and its determinants. We conducted a population-based cohort study within the Generation R study, in 2637 pregnant women. The concordance between self-reported medication data and pharmacy records was calculated for different therapeutic classes using Yule's Y. We evaluated a number of variables as determinant of discordance between both sources through univariate and multivariate logistic regression analysis. The concordance between self-reports and pharmacy records was moderate to good for medications used for chronic conditions, such as selective serotonin reuptake inhibitors or anti-asthmatic medications (0.88 and 0.68, respectively). Medications that are used occasionally, such as antibiotics, had a lower concordance (0.51). Women with a Turkish or other non-Western background were more likely to demonstrate discordance between pharmacy records and self-reported data compared with women with a Dutch background (Turkish: odds ratio, 1.63; 95% confidence interval, 1.16-2.29; other non-Western: odds ratio, 1.33; 95% confidence interval, 1.03-1.71). Further research is needed to assess how the cultural or ethnic differences may affect the concordance or discordance between both medication sources. The results of this study showed that the use of multiple sources is needed to have a good estimation of the medication use during pregnancy. Copyright © 2017 John Wiley & Sons, Ltd.

Privacy, confidentiality, and electronic medical records.

OpenAIRE

Barrows, R C; Clayton, P D

1996-01-01

The enhanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medical records and discuss nontechnical and technical aspects that constitute a reasonable security solution. It is argued that with gui...

The design and implementation of online medical record system ...

African Journals Online (AJOL)

The design and implementation of online medical record system (OMRS) ... PROMOTING ACCESS TO AFRICAN RESEARCH. AFRICAN JOURNALS ONLINE (AJOL) ... International Journal of Natural and Applied Sciences. Journal Home ...

Self-reported cannabis use characteristics, patterns and helpfulness among medical cannabis users.

Science.gov (United States)

Bonn-Miller, Marcel O; Boden, Matthew Tyler; Bucossi, Meggan M; Babson, Kimberly A

2014-01-01

Little research has investigated the demographic and symptom profile of medical cannabis users in states in the USA that have legalized cannabis use. In the present cross-sectional study, we investigated the demographic profile of 217 adults currently receiving medical cannabis, as well as differences in problematic use and perceived helpfulness in terms of (i) symptoms of psychological disorders and pain, and (ii) motives for use. Findings indicated that medical cannabis users (i) use and perceive cannabis to be beneficial for multiple conditions, some for which cannabis is not specifically prescribed or allowed at the state level; and (ii) report similar rates of disordered use as compared with population estimates among regular users. Furthermore, problematic cannabis use was predicted by several symptoms of psychological disorders (e.g. depression) and a variety of use motives (e.g. coping), while cannabis was reported as particularly helpful among those with several psychological symptoms (e.g. traumatic intrusions), as well as those reporting use for social anxiety reasons. Results are discussed in terms of future directions for research given the current debates regarding legalization of cannabis for medical purposes and, more generally, the lack of empirical data to inform such debates.

Cancer symptom awareness and barriers to medical help seeking in Scottish adolescents: a cross-sectional study

OpenAIRE

Hubbard, Gill; Macmillan, Iona; Canny, Anne; Forbat, Liz; Neal, Richard D; O’Carroll, Ronan E; Haw, Sally; Kyle, Richard G

2014-01-01

Background Initiatives to promote early diagnosis include raising public awareness of signs and symptoms of cancer and addressing barriers to seeking medical help about cancer. Awareness of signs and symptoms of cancer and emotional barriers, such as, fear, worry, and embarrassment strongly influence help seeking behaviour. Whether anxiety influences seeking medical help about cancer is not known. The purpose of this study about adolescents was to examine: 1) the relationship between contextu...

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.

Data-mining of medication records to improve asthma management.

Science.gov (United States)

Bereznicki, Bonnie J; Peterson, Gregory M; Jackson, Shane L; Walters, E Haydn; Fitzmaurice, Kimbra D; Gee, Peter R

2008-07-07

To use community pharmacy medication records to identify patients whose asthma may not be well managed and then implement and evaluate a multidisciplinary educational intervention to improve asthma management. We used a multisite controlled study design. Forty-two pharmacies throughout Tasmania ran a software application that "data-mined" medication records, generating a list of patients who had received three or more canisters of inhaled short-acting beta(2)-agonists in the preceding 6 months. The patients identified were allocated to an intervention or control group. Pre-intervention data were collected for the period May to November 2006 and post-intervention data for the period December 2006 to May 2007. Intervention patients were contacted by the community pharmacist via mail, and were sent educational material and a letter encouraging them to see their general practitioner for an asthma management review. Pharmacists were blinded to the control patients' identities until the end of the post-intervention period. Dispensing ratio of preventer medication (inhaled corticosteroids [ICSs]) to reliever medication (inhaled short-acting beta(2)-agonists). Thirty-five pharmacies completed the study, providing 702 intervention and 849 control patients. The intervention resulted in a threefold increase in the preventer-to-reliever ratio in the intervention group compared with the control group (P < 0.01) and a higher proportion of patients in the intervention group using ICS therapy than in the control group (P < 0.01). Community pharmacy medication records can be effectively used to identify patients with suboptimal asthma management, who can then be referred to their GP for review. The intervention should be trialled on a national scale to determine the effects on clinical, social, emotional and economic outcomes for people in the Australian community, with a longer follow-up to determine sustainability of the improvements noted.

7 CFR 110.5 - Availability of records to facilitate medical treatment.

Science.gov (United States)

2010-01-01

... pesticide required to be maintained under § 110.3 is necessary to provide medical treatment or first aid to... care professional, to be a medical emergency, the record information of the restricted use pesticide, relating to the medical emergency, shall be provided immediately. (b)(1) The attending licensed health care...

Digital Sport Medical Record: Sigh or a blessing?

NARCIS (Netherlands)

Stege, J.P.; Fleuren, M.A.H.; van der Knaap, E.T.W.; Stubbe, J.H.

2013-01-01

Since 2004, there have been several initiatives regarding the development of a digital Sport Medical Record (SMD). Interviews with the Netherlands Association of Sports Medicine (VSG) show that there are particular problems with commissioning of the digital SMD. During spring 2012, two focus group

Automatic health record review to help prioritize gravely ill Social Security disability applicants.

Science.gov (United States)

Abbott, Kenneth; Ho, Yen-Yi; Erickson, Jennifer

2017-07-01

Every year, thousands of patients die waiting for disability benefits from the Social Security Administration. Some qualify for expedited service under the Compassionate Allowance (CAL) initiative, but CAL software focuses exclusively on information from a single form field. This paper describes the development of a supplemental process for identifying some overlooked but gravely ill applicants, through automatic annotation of health records accompanying new claims. We explore improved prioritization instead of fully autonomous claims approval. We developed a sample of claims containing medical records at the moment of arrival in a single office. A series of tools annotated both patient records and public Web page descriptions of CAL medical conditions. We trained random forests to identify CAL patients and validated each model with 10-fold cross validation. Our main model, a general CAL classifier, had an area under the receiver operating characteristic curve of 0.915. Combining this classifier with existing software improved sensitivity from 0.960 to 0.994, detecting every deceased patient, but reducing positive predictive value to 0.216. True positive CAL identification is a priority, given CAL patient mortality. Mere prioritization of the false positives would not create a meaningful burden in terms of manual review. Death certificate data suggest the presence of truly ill patients among putative false positives. To a limited extent, it is possible to identify gravely ill Social Security disability applicants by analyzing annotations of unstructured electronic health records, and the level of identification is sufficient to be useful in prioritizing case reviews. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the US.

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 .

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

Science.gov (United States)

Cao, Hui; Stetson, Peter; Hripcsak, George

2003-01-01

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

Audit of Medical Records of Shahid Madani Hospital

Directory of Open Access Journals (Sweden)

Mohammad farough-khosravi

2016-12-01

Full Text Available Background and Objectives: Evaluation of the quality of services and provided cares through comparing them with existing standards in order to identify and prioritize problems and trying to fix them are important steps in the audit of clinical functions. This study aimed to improve the quality of performance of medical records registrations about patients admitted to hospital Shahid Madani and deals with the audit of records listed them. Material and Methods: To perform this study, data were collected using researcher checklist. Target data of 30 medical records were gathered. We used software package of Mini Tab and SPSS to develop process statistical control charts and for statistical analysis of data, respectively. Results: By plotting control charts, we determined three specific reasons in the ADMISSION AND DISCHARGE SUMMARY SHEET, four specific reasons in the SUMMARY SHEET, and three specific reasons in CONSULTATION REQUEST SHEET. The lack of the standard form (on-delivered copies of a summary form “with 90%”, lack of the main form in patient's clinical record “with 83.3%”, lack of the patient's procedure “with 73.3%”are ranked as the most defects in SUMMARY SHEET. In the CONSULTATION REQUEST SHEET, failure to comply with doctor's stamp and signature standard with “20%” has highest percentage of defects. In the ADMISSION AND DISCHARGE SUMMARY SHEET nonconformity of standard records, patient's duration of stay “100%”, coding of diseases based on ICD"100%", recording of patient number based on signs and symptoms "93.3%", usingthe abbreviations to record the recognitions "93.3%" have highest percentage of defects respectively. Conclusion: Based on the results of this study and noting that studied standards of process statistical control charts are in the range of control, the quality of standards and the documentations of  the records

Introduction of an automated medical record at an HMO clinic.

Science.gov (United States)

Churgin, P G

1994-01-01

In May 1993, CIGNA Healthcare of Arizona implemented a comprehensive automated medical record system in a pilot project performed at a primary care clinic in Chandler, Arizona. The system, EpicCare, operates in a client-server environment and completely replaces the paper chart in all phases of medical care. After six months of use by 10 medical providers and a 50-member staff, the system has been approved by clinicians, staff, and patients.

Minimal impact of an electronic medical records system.

Science.gov (United States)

Tall, Jill M; Hurd, Marie; Gifford, Thomas

2015-05-01

Electronic medical records (EMRs) implementation in hospitals and emergency departments (EDs) is becoming increasingly more common. The purpose of this study was to determine the impact of an EMR system on patient-related factors that correlate to ED workflow efficiency. A retrospective chart review assessed monthly census reports of all patients who registered and were treated to disposition during conversion from paper charts to an EMR system. The primary outcome measurement was an analysis of the time of registration to discharge or total ED length of stay as well as rate of those who left without being seen, eloped, or left against medical advice. These data were recorded from 3 periods, for 18 months: before installation of the EMR system (pre-EMR), during acclimation to the EMR, and post acclimation (post-EMR). A total of 61626 individual patient records were collected and analyzed. The total ED length of stay across all patient subtypes was not significantly affected by the installation of the hospital-wide EMR system (P = .481); however, a significant decrease was found for patients who were admitted to the hospital from the ED (P .25). Installation of a hospital-wide EMR system had minimal impact on workflow efficiency parameters in an ED. Copyright © 2015 Elsevier Inc. All rights reserved.

Virtual classroom helps medical education for both Chinese and foreign students.

Science.gov (United States)

Shi, C; Wang, L; Li, X; Chai, S; Niu, W; Kong, Y; Zhou, W; Yin, W

2015-11-01

The rapid development of computer and internet technology has a strong influence over one's quality of education within different fields of study. To determine the potential benefits of introducing internet into medical school classes, a pilot study was conducted in three different Chinese medical schools. Seven hundred and eight medical school undergraduates, 385 dental school students and 366 foreign students were randomly recruited to complete a self-administered questionnaire. The contents included personal information, current usage of computer and internet, and attitudes towards the computerised teaching methods. Two forum groups were created using instant message software and were randomly assigned to two classes, allowing students to freely ask or discuss questions with the help of their teachers in these two virtual classrooms. All 1539 questionnaires were accepted and analysed. Although there were some differences between Chinese and foreign undergraduates, both group of students were highly proficient in internet usage and navigation. Overwhelmingly, 88.37% of the students owned a computer and frequently logged onto the internet. Most of them believed that the internet is a helpful adjunct to their studies and held positive attitudes towards computerised teaching. Compared to the classes that were not assigned internet forums, the two experimental classes performed significantly better on the examination. Our results suggest that computerised teaching methods have significant potential to assist in learning for both Chinese and foreign medical undergraduates. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

FRR: fair remote retrieval of outsourced private medical records in electronic health networks.

Science.gov (United States)

Wang, Huaqun; Wu, Qianhong; Qin, Bo; Domingo-Ferrer, Josep

2014-08-01

Cloud computing is emerging as the next-generation IT architecture. However, cloud computing also raises security and privacy concerns since the users have no physical control over the outsourced data. This paper focuses on fairly retrieving encrypted private medical records outsourced to remote untrusted cloud servers in the case of medical accidents and disputes. Our goal is to enable an independent committee to fairly recover the original private medical records so that medical investigation can be carried out in a convincing way. We achieve this goal with a fair remote retrieval (FRR) model in which either t investigation committee members cooperatively retrieve the original medical data or none of them can get any information on the medical records. We realize the first FRR scheme by exploiting fair multi-member key exchange and homomorphic privately verifiable tags. Based on the standard computational Diffie-Hellman (CDH) assumption, our scheme is provably secure in the random oracle model (ROM). A detailed performance analysis and experimental results show that our scheme is efficient in terms of communication and computation. Copyright © 2014 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2014-10-01

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

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

Science.gov (United States)

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

2017-06-23

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

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

Science.gov (United States)

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

2015-06-01

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

Helping Older Adults Improve Their Medication Experience (HOME) by Addressing Medication Regimen Complexity in Home Healthcare.

Science.gov (United States)

Sheehan, Orla C; Kharrazi, Hadi; Carl, Kimberly J; Leff, Bruce; Wolff, Jennifer L; Roth, David L; Gabbard, Jennifer; Boyd, Cynthia M

In skilled home healthcare (SHHC), communication between nurses and physicians is often inadequate for medication reconciliation and needed changes to the medication regimens are rarely made. Fragmentation of electronic health record (EHR) systems, transitions of care, lack of physician-nurse in-person contact, and poor understanding of medications by patients and their families put patients at risk for serious adverse outcomes. The aim of this study was to develop and test the HOME tool, an informatics tool to improve communication about medication regimens, share the insights of home care nurses with physicians, and highlight to physicians and nurses the complexity of medication schedules. We used human computer interaction design and evaluation principles, automated extraction from standardized forms, and modification of existing EHR fields to highlight key medication-related insights that had arisen during the SHHC visit. Separate versions of the tool were developed for physicians/nurses and patients/caregivers. A pilot of the tool was conducted using 20 SHHC encounters. Home care nurses and physicians found the tool useful for communication. Home care nurses were able to implement the HOME tool into their clinical workflow and reported improved communication with physicians about medications. This simple and largely automated tool improves understanding and communication around medications in SHHC.

A Primer on Endoscopic Electronic Medical Records

OpenAIRE

Atreja, Ashish; Rizk, Maged; Gurland, Brooke

2010-01-01

Endoscopic electronic medical record systems (EEMRs) are now increasingly utilized in many endoscopy centers. Modern EEMRs not only support endoscopy report generation, but often include features such as practice management tools, image and video clip management, inventory management, e-faxes to referring physicians, and database support to measure quality and patient outcomes. There are many existing software vendors offering EEMRs, and choosing a software vendor can be time consuming and co...

Contribution of Electronic Medical Records to the Management of Rare Diseases

Directory of Open Access Journals (Sweden)

Dominique Bremond-Gignac

2015-01-01

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

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2017-05-01

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

Evaluation Existential of Medical Record Laboratory at the Diploma 3 Program for Medical Record & Health Information, Mathematics and Natural Science Faculty, Gadjah Mada University

Directory of Open Access Journals (Sweden)

Savitri Citra Budi

2009-06-01

Evaluation on the existence of laboratory was presumably exploited to consider future development and management as expected that this Laboratory could be taken as example for medical record management in hospitals.

Attitudes toward inter-hospital electronic patient record exchange: discrepancies among physicians, medical record staff, and patients.

Science.gov (United States)

Wang, Jong-Yi; Ho, Hsiao-Yun; Chen, Jen-De; Chai, Sinkuo; Tai, Chih-Jaan; Chen, Yung-Fu

2015-07-12

In this era of ubiquitous information, patient record exchange among hospitals still has technological and individual barriers including resistance to information sharing. Most research on user attitudes has been limited to one type of user or aspect. Because few analyses of attitudes toward electronic patient records (EPRs) have been conducted, understanding the attitudes among different users in multiple aspects is crucial to user acceptance. This proof-of-concept study investigated the attitudes of users toward the inter-hospital EPR exchange system implemented nationwide and focused on discrepant behavioral intentions among three user groups. The system was designed by combining a Health Level 7-based protocol, object-relational mapping, and other medical informatics techniques to ensure interoperability in realizing patient-centered practices. After implementation, three user-specific questionnaires for physicians, medical record staff, and patients were administered, with a 70 % response rate. The instrument showed favorable convergent construct validity and internal consistency reliability. Two dependent variables were applied: the attitudes toward privacy and support. Independent variables comprised personal characteristics, work characteristics, human aspects, and technology aspects. Major statistical methods included exploratory factor analysis and general linear model. The results from 379 respondents indicated that the patients highly agreed with privacy protection by their consent and support for EPRs, whereas the physicians remained conservative toward both. Medical record staff was ranked in the middle among the three groups. The three user groups demonstrated discrepant intentions toward privacy protection and support. Experience of computer use, level of concerns, usefulness of functions, and specifically, reason to use electronic medical records and number of outpatient visits were significantly associated with the perceptions. Overall, four

42 CFR 482.24 - Condition of participation: Medical record services.

Science.gov (United States)

2010-10-01

... anesthesia services. (B) An updated examination of the patient, including any changes in the patient's... practitioners' orders, nursing notes, reports of treatment, medication records, radiology, and laboratory...

Cancer symptom awareness and barriers to medical help seeking in Scottish adolescents: a cross-sectional study.

Science.gov (United States)

Hubbard, Gill; Macmillan, Iona; Canny, Anne; Forbat, Liz; Neal, Richard D; O'Carroll, Ronan E; Haw, Sally; Kyle, Richard G

2014-10-29

Initiatives to promote early diagnosis include raising public awareness of signs and symptoms of cancer and addressing barriers to seeking medical help about cancer. Awareness of signs and symptoms of cancer and emotional barriers, such as fear, worry, and embarrassment, strongly influence help seeking behaviour. Whether anxiety influences seeking medical help about cancer is not known. The purpose of this study about adolescents was to examine: 1) the relationship between contextual factors and awareness of signs and symptoms of cancer and barriers (including emotional barriers) to seeking medical help, and 2) associations between anxiety and endorsed barriers to seeking medical help. Interpretation of data is informed by the common sense model of the self-regulation of health and illness. A cross-sectional study of 2,173 Scottish adolescents (age 12/13 years) using the Cancer Awareness Measure. Socio-demographic questions were also included. Descriptive statistics were calculated and two Poisson regression models were built to determine independent predictors of: 1) the number of cancer warning signs recognized, and; 2) number of barriers to help seeking endorsed. Analysis identified that knowing someone with cancer was a significant independent predictor of recognising more cancer warning signs whereas Black and Minority Ethnic status was a significant independent predictor of recognising fewer cancer warning signs. Emotional barriers were the most commonly endorsed, followed by family, service and practical barriers. Over two thirds of adolescents were 'worried about what the doctor would find' and over half were 'scared'. Higher anxiety scores, knowing more cancer warning signs and female gender were significant independent predictors of barriers to help seeking. Improving cancer awareness and help seeking behaviour during adolescence may contribute to early presentation. Contextual factors (for example, ethnicity, gender, knowing someone with cancer), and

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.

Personal health records as portal to the electronic medical record.

Science.gov (United States)

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

2014-03-01

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

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.

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

Science.gov (United States)

Mocanu, Mihai; Mocanu, Carmen

2007-01-01

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

Electronic medical records: a developing and developed country analysis

CSIR Research Space (South Africa)

Sikhondze, NC

2016-05-01

Full Text Available of Electronic Medical Records (EMR) systems in developed and developing countries. There is a direct relationship between the income of the country and the use of electronic information and communication systems as part of healthcare systems hence the division...

Collaborative Affordances of Medical Records

DEFF Research Database (Denmark)

Bardram, Jakob Eyvind; Houben, Steven

2017-01-01

by Sellen and Harper (2003) on the affordances of physical paper. Sellen and Harper describe how the physical properties of paper affords easy reading, navigation, mark-up, and writing, but focuses, we argue, mainly on individual use of paper and digital technology. As an extension to this, Collaborative...... Affordances; being portable across patient wards and the entire hospital, by providing collocated access, by providing a shared overview of medical data, and by giving clinicians ways to maintain mutual awareness. We then discuss how the concept of Collaborative Affordances can be used in the design of new...... technology by providing a design study of a ‘Hybrid Patient Record’ (HyPR), which is designed to seamlessly blend and integrate paper-based with electronic patient records....

Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study.

Science.gov (United States)

Pattyn, E; Verhaeghe, M; Sercu, C; Bracke, P

2013-10-01

This study contrasts the medicalized conceptualization of mental illness with psychologizing mental illness and examines what the consequences are of adhering to one model versus the other for help seeking and stigma. The survey "Stigma in a Global Context-Belgian Mental Health Study" (2009) conducted face-to-face interviews among a representative sample of the general Belgian population using the vignette technique to depict schizophrenia (N = 381). Causal attributions, labeling processes, and the disease view are addressed. Help seeking refers to open-ended help-seeking suggestions (general practitioner, psychiatrist, psychologist, family, friends, and self-care options). Stigma refers to social exclusion after treatment. The data are analyzed by means of logistic and linear regression models in SPSS Statistics 19. People who adhere to the biopsychosocial (versus psychosocial) model are more likely to recommend general medical care and people who apply the disease view are more likely to recommend specialized medical care. Regarding informal help, those who prefer the biopsychosocial model are less likely to recommend consulting friends than those who adhere to the psychosocial model. Respondents who apply a medical compared to a non-medical label are less inclined to recommend self-care. As concerns treatment stigma, respondents who apply a medical instead of a non-medical label are more likely to socially exclude someone who has been in psychiatric treatment. Medicalizing mental illness involves a package deal: biopsychosocial causal attributions and applying the disease view facilitate medical treatment recommendations, while labeling seems to trigger stigmatizing attitudes.

A retrospective analysis of medical record use in e-consultations.

Science.gov (United States)

Pecina, Jennifer L; North, Frederick

2017-06-01

Introduction Under certain circumstances, e-consultations can substitute for a face-to-face consultation. A basic requirement for a successful e-consultation is that the e-consultant has access to important medical history and exam findings along with laboratory and imaging results. Knowing just what information the specialist needs to complete an e-consultation is a major challenge. This paper examines differences between specialties in their need for past information from laboratory, imaging and clinical notes. Methods This is a retrospective study of patients who had an internal e-consultation performed at an academic medical centre. We reviewed a random sample of e-consultations that occurred in the first half of 2013 for the indication for the e-consultation and whether the e-consultant reviewed data in the medical record that was older than one year to perform the e-consultation. Results Out of 3008 total e-consultations we reviewed 360 (12%) randomly selected e-consultations from 12 specialties. Questions on management (35.8%), image results (27.2%) and laboratory results (25%) were the three most common indications for e-consultation. E-consultants reviewed medical records in existence more than one year prior to the e-consultation 146 (40.6%) of the time with e-consultants in the specialties of endocrinology, haematology and rheumatology, reviewing records older than one year more than half the time. Labs (20.3%), office notes (20%) and imaging (17.8%) were the types of medical data older than one year that were reviewed the most frequently overall. Discussion Management questions appear to be the most common reason for e-consultation. E-consultants frequently reviewed historical medical data that is older than one year at the time of the e-consultation, especially in endocrinology, haematology and rheumatology specialties. Practices engaging in e-consultations that require transfer of data may want to include longer time frames of historical information

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 ...

Patients Reading Their Medical Records: Differences in Experiences and Attitudes between Regular and Inexperienced Readers

Science.gov (United States)

Huvila, Isto; Daniels, Mats; Cajander, Åsa; Åhlfeldt, Rose-Mharie

2016-01-01

Introduction: We report results of a study of how ordering and reading of printouts of medical records by regular and inexperienced readers relate to how the records are used, to the health information practices of patients, and to their expectations of the usefulness of new e-Health services and online access to medical records. Method: The study…

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.

Electronic Health Record Impacts on Family Medicine Teachers: Survey of Third-Year Medical Student Clerkship Preceptors at an Academic Medical Center.

Science.gov (United States)

Curry, Elizabeth; Oser, Tamara K; Oser, Sean M

2017-10-01

Electronic Health Record (EHR) use in clinical practice has accelerated in recent years. While several aspects of EHR use have been extensively studied, there is little data on EHR impacts on medical student educators, especially those involved in outpatient family medicine. This study evaluated perceived impacts of EHR use on clinician teachers of outpatient family medicine. The study used a mixed methods survey of clinicians who teach third-year medical students during the required family and community medicine outpatient clerkship at a Mid-Atlantic medical school. Among 50 completed surveys, most respondents reported that the EHR had impacted their teaching (70% reported at least one negative effect; 84% reported at least one positive effect). Positive impacts included more easily viewing information, more effectively teaching evidence-based medicine, and teaching about EHR use itself. Negative impacts included less time teaching or interacting with students, and a perception that EHR use impedes development of students' critical thinking and clinical integration skills. Providers who have taught medical students both with and without EHR in place (>P=.024), those over 50 years old (>P=.019), and those with at least 5 years teaching experience (>P=.006) were more likely to report negative impacts. Most preceptors reported that EHR use had both positive and negative impacts on their teaching of medical students, though the negative effects were perceived by respondents as more substantial, consistent with a theme of decreased enthusiasm for teaching due to EHR use. These findings can be used to help inform faculty development and education initiatives.

Identification of Units and Other Terms in Czech Medical Records

Czech Academy of Sciences Publication Activity Database

Zvára Jr., Karel; Kašpar, Václav

2010-01-01

Roč. 6, č. 1 (2010), s. 78-82 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : natural language processing * healthcare documentation * medical reports * EHR * finite-state machine * regular expression Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/en/ejbi/article/61-en-identification-of-units-and-other-terms-in-czech-medical-records.html

Anonymization of Electronic Medical Records to Support Clinical Analysis

CERN Document Server

Gkoulalas-Divanis, Aris

2013-01-01

Anonymization of Electronic Medical Records to Support Clinical Analysis closely examines the privacy threats that may arise from medical data sharing, and surveys the state-of-the-art methods developed to safeguard data against these threats. To motivate the need for computational methods, the book first explores the main challenges facing the privacy-protection of medical data using the existing policies, practices and regulations. Then, it takes an in-depth look at the popular computational privacy-preserving methods that have been developed for demographic, clinical and genomic data sharing, and closely analyzes the privacy principles behind these methods, as well as the optimization and algorithmic strategies that they employ. Finally, through a series of in-depth case studies that highlight data from the US Census as well as the Vanderbilt University Medical Center, the book outlines a new, innovative class of privacy-preserving methods designed to ensure the integrity of transferred medical data for su...

Patients, privacy and trust: patients' willingness to allow researchers to access their medical records.

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Damschroder, Laura J; Pritts, Joy L; Neblo, Michael A; Kalarickal, Rosemarie J; Creswell, John W; Hayward, Rodney A

2007-01-01

The federal Privacy Rule, implemented in the United States in 2003, as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), created new restrictions on the release of medical information for research. Many believe that its restrictions have fallen disproportionately on researchers prompting some to call for changes to the Rule. Here we ask what patients think about researchers' access to medical records, and what influences these opinions. A sample of 217 patients from 4 Veteran Affairs (VA) facilities deliberated in small groups at each location with the opportunity to question experts and inform themselves about privacy issues related to medical records research. After extensive deliberation, these patients were united in their inclination to share their medical records for research. Yet they were also united in their recommendations to institute procedures that would give them more control over whether and how their medical records are used for research. We integrated qualitative and quantitative results to derive a better understanding of this apparent paradox. Our findings can best be presented as answers to questions related to five dimensions of trust: Patients' trust in VA researchers was the most powerful determinant of the kind of control they want over their medical records. More specifically, those who had lower trust in VA researchers were more likely to recommend a more stringent process for obtaining individual consent. Insights on the critical role of trust suggest actions that researchers and others can take to more fully engage patients in research.

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

Directory of Open Access Journals (Sweden)

Anant Raut

2017-06-01

Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

Infant feeding practices within a large electronic medical record database.

Science.gov (United States)

Bartsch, Emily; Park, Alison L; Young, Jacqueline; Ray, Joel G; Tu, Karen

2018-01-02

The emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices. We completed a population-based retrospective cohort study of 8815 singleton infants born at term in Ontario, Canada, April 2002 to March 2013. Newborn records were linked to the Electronic Medical Record Administrative data Linked Database (EMRALD™), which uses patient-level information from participating family practice EMRs across Ontario. We assessed exclusive breastfeeding patterns using an automated electronic search algorithm, with manual review of EMRs when the latter was not possible. We examined the rate of breastfeeding at visits corresponding to 2, 4 and 6 months of age, as well as sociodemographic factors associated with exclusive breastfeeding. Of the 8815 newborns, 1044 (11.8%) lacked breastfeeding information in their EMR. Rates of exclusive breastfeeding were 39.5% at 2 months, 32.4% at 4 months and 25.1% at 6 months. At age 6 months, exclusive breastfeeding rates were highest among mothers aged ≥40 vs. database.

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

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

2005-01-01

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

Validity of a hospital-based obstetric register using medical records as reference

DEFF Research Database (Denmark)

Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed

2015-01-01

BACKGROUND: Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. OBJECTIVE: To assess completeness...... and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database...... Database therefore offers a valuable source for examining clinical, administrative, and research questions....

Privacy-Preserving Self-Helped Medical Diagnosis Scheme Based on Secure Two-Party Computation in Wireless Sensor Networks

Directory of Open Access Journals (Sweden)

Yi Sun

2014-01-01

Full Text Available With the continuing growth of wireless sensor networks in pervasive medical care, people pay more and more attention to privacy in medical monitoring, diagnosis, treatment, and patient care. On one hand, we expect the public health institutions to provide us with better service. On the other hand, we would not like to leak our personal health information to them. In order to balance this contradiction, in this paper we design a privacy-preserving self-helped medical diagnosis scheme based on secure two-party computation in wireless sensor networks so that patients can privately diagnose themselves by inputting a health card into a self-helped medical diagnosis ATM to obtain a diagnostic report just like drawing money from a bank ATM without revealing patients’ health information and doctors’ diagnostic skill. It makes secure self-helped disease diagnosis feasible and greatly benefits patients as well as relieving the heavy pressure of public health institutions.

Balancing your personal and professional lives: help for busy medical practice employees.

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Hills, Laura Sachs

2008-01-01

It is extremely difficult for most people to balance work and home life. This is especially true of employees who work in fast-paced medical practices where they are on the go all day. Each medical practice employee must find his or her own way to balance work and life, but fortunately, the process can usually be boiled down to some basics. This article outlines a strategy for establishing the top five priorities in the medical practice employee's life. It suggests that medical practice personnel can develop and use a personal mission statement as a life guide. This article also suggests specific strategies medical practice employees can use to protect and make the best use of their private time. It provides examples of how medical practice personnel have changed their lives by dropping unnecessary activities from their daily schedules. Finally, this article offers guidance about getting children to help working parents balance their work and private lives, 10 additional tips for work/life balance, a work/life balance self-assessment quiz, and a template the medical practice employee can use to create a customized personal mission statement.

Towards Standardized Patient Data Exchange: Integrating a FHIR Based API for the Open Medical Record System.

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

2015-01-01

Interoperability is essential to address limitations caused by the ad hoc implementation of clinical information systems and the distributed nature of modern medical care. The HL7 V2 and V3 standards have played a significant role in ensuring interoperability for healthcare. FHIR is a next generation standard created to address fundamental limitations in HL7 V2 and V3. FHIR is particularly relevant to OpenMRS, an Open Source Medical Record System widely used across emerging economies. FHIR has the potential to allow OpenMRS to move away from a bespoke, application specific API to a standards based API. We describe efforts to design and implement a FHIR based API for the OpenMRS platform. Lessons learned from this effort were used to define long term plans to transition from the legacy OpenMRS API to a FHIR based API that greatly reduces the learning curve for developers and helps enhance adhernce to standards.

Paper-Based Medical Records: the Challenges and Lessons Learned from Studying Obstetrics and Gynaecological Post-Operation Records in a Nigerian Hospital

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Adekunle Yisau Abdulkadir

2010-10-01

Full Text Available AIM: With the background knowledge that auditing of Medical Records (MR for adequacy and completeness is necessary if it is to be useful and reliable in continuing patient care; protection of the legal interest of the patient, physicians, and the Hospital; and meeting requirements for researches, we scrutinized theatre records of our hospital to identify routine omissions or deficiencies, and correctable errors in our MR system. METHOD: Obstetrics and Gynaecological post operation theatre records between January 2006 and December 2008 were quantitatively and qualitatively analyzed for details that included: hospital number; Patients age; diagnosis; surgery performed; types and modes of anesthesia; date of surgery; patients’ ward; Anesthetists names; surgeons and attending nurses names, and abbreviations used with SPSS 15.0 for Windows. RESULTS: Hardly were any of the 1270 surgeries during the study period documented without an omission or an abbreviation. Hospital numbers and patients’ age were not documented in 21.8% (n=277 and 59.1% (n=750 respectively. Diagnoses and surgeries were recorded with varying abbreviations in about 96% of instances. Surgical team names were mostly abbreviated or initials only given. CONCLUSION: To improve the quality of Paper-based Medical Record, regular auditing, training and good orientation of medical personnel for good record practices, and discouraging large volume record book to reduce paper damages and sheet loss from handling are necessary else what we record toady may neither be useful nor available tomorrow. [TAF Prev Med Bull 2010; 9(5.000: 427-432

The realization of the storage of XML and middleware-based data of electronic medical records

International Nuclear Information System (INIS)

Liu Shuzhen; Gu Peidi; Luo Yanlin

2007-01-01

In this paper, using the technology of XML and middleware to design and implement a unified electronic medical records storage archive management system and giving a common storage management model. Using XML to describe the structure of electronic medical records, transform the medical data from traditional 'business-centered' medical information into a unified 'patient-centered' XML document and using middleware technology to shield the types of the databases at different departments of the hospital and to complete the information integration of the medical data which scattered in different databases, conducive to information sharing between different hospitals. (authors)

The PHARMS (Patient Held Active Record of Medication Status) feasibility study: a research proposal.

LENUS (Irish Health Repository)

Walsh, Elaine

2018-01-08

Medication errors are a major source of preventable morbidity, mortality and cost and many occur at the times of hospital admission and discharge. Novel interventions (such as new methods of recording medication information and conducting medication reconciliation) are required to facilitate accurate transfer of medication information. With existing evidence supporting the use of information technology and the patient representing the one constant in the care process, an electronic patient held medication record may provide a solution. This study will assess the feasibility of introducing a patient held electronic medication record in primary and secondary care using the Consolidated Framework for Implementation Research (CFIR).This feasibility study is a mixed method study of community dwelling older adult patients admitted to an urban secondary care facility comprising a non-randomised intervention and qualitative interviews with key stakeholders. Outcomes of interest include clinical outcomes and process evaluation.This study will yield insights pertaining to feasibility, acceptability and participation for a more definitive evaluation of the intervention. The study also has the potential to contribute to knowledge of implementation of technology in a healthcare context and to the broader area of implementation science.

Evaluation of medication errors with implementation of electronic health record technology in the medical intensive care unit

Directory of Open Access Journals (Sweden)

Liao TV

2017-05-01

Full Text Available T Vivian Liao,1 Marina Rabinovich,2 Prasad Abraham,2 Sebastian Perez,3 Christiana DiPlotti,4 Jenny E Han,5 Greg S Martin,5 Eric Honig5 1Department of Pharmacy Practice, College of Pharmacy, Mercer Health Sciences Center, 2Department of Pharmacy and Clinical Nutrition, Grady Health System, 3Department of Surgery, Emory University, 4Pharmacy, Ingles Markets, 5Department of Medicine, Emory University, Atlanta, GA, USA Purpose: Patients in the intensive care unit (ICU are at an increased risk for medication errors (MEs and adverse drug events from multifactorial causes. ME rate ranges from 1.2 to 947 per 1,000 patient days in the medical ICU (MICU. Studies with the implementation of electronic health records (EHR have concluded that it significantly reduced overall prescribing errors and the number of errors that caused patient harm decreased. However, other types of errors, such as wrong dose and omission of required medications increased after EHR implementation. We sought to compare the number of MEs before and after EHR implementation in the MICU, with additional evaluation of error severity.Patients and methods: Prospective, observational, quality improvement study of all patients admitted to a single MICU service at an academic medical center. Patients were evaluated during four periods over 2 years: August–September 2010 (preimplementation; period I, January–February 2011 (2 months postimplementation; period II, August–September 2012 (21 months postimplementation; period III, and January–February 2013 (25 months postimplementation; period IV. All medication orders and administration records were reviewed by an ICU clinical pharmacist and ME was defined as a deviation from established standards for prescribing, dispensing, administering, or documenting medication. The frequency and classification of MEs were compared between groups by chi square; p<0.05 was considered significant.Results: There was a statistically significant increase

The Impact of Stigma and Personal Experiences on the Help-Seeking Behaviors of Medical Students With Burnout.

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Dyrbye, Liselotte N; Eacker, Anne; Durning, Steven J; Brazeau, Chantal; Moutier, Christine; Massie, F Stanford; Satele, Daniel; Sloan, Jeff A; Shanafelt, Tait D

2015-07-01

Because of the high prevalence of burnout among medical students and its association with professional and personal consequences, the authors evaluated the help-seeking behaviors of medical students with burnout and compared their stigma perceptions with those of the general U.S. population and age-matched individuals. The authors surveyed students at six medical schools in 2012. They measured burnout, symptoms of depression, and quality of life using validated instruments and explored help-seeking behaviors, perceived stigma, personal experiences, and attitudes toward seeking mental health treatment. Of 2,449 invited students, 873 (35.6%) responded. A third of respondents with burnout (154/454; 33.9%) sought help for an emotional/mental health problem in the last 12 months. Respondents with burnout were more likely than those without burnout to agree or strongly agree with 8 of 10 perceived stigma items. Respondents with burnout who sought help in the last 12 months were twice as likely to report having observed supervisors negatively judge students who sought care (odds ratio [OR] 2.06 [95% confidence interval (CI) 1.25-3.39], P student's emotional/mental health problem to others (OR 1.63 [95% CI 1.08-2.47], P = .02). A smaller percentage of respondents would definitely seek professional help for a serious emotional problem (235/872; 26.9%) than of the general population (44.3%) and age-matched individuals (38.8%). Only a third of medical students with burnout seek help. Perceived stigma, negative personal experiences, and the hidden curriculum may contribute.

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).

Frequency, comprehension and attitudes of physicians towards abbreviations in the medical record.

Science.gov (United States)

Hamiel, Uri; Hecht, Idan; Nemet, Achia; Pe'er, Liron; Man, Vitaly; Hilely, Assaf; Achiron, Asaf

2018-05-01

Abbreviations are common in the medical record. Their inappropriate use may ultimately lead to patient harm, yet little is known regarding the extent of their use and their comprehension. Our aim was to assess the extent of their use, their comprehension and physicians' attitudes towards them, using ophthalmology consults in a tertiary hospital as a model. We first mapped the frequency with which English abbreviations were used in the departments' computerised databases. We then used the most frequently used abbreviations as part of a cross-sectional survey designed to assess the attitudes of non-ophthalmologist physicians towards the abbreviations and their comprehension of them. Finally, we tested whether an online lecture would improve comprehension. 4375 records were screened, and 235 physicians responded to the survey. Only 42.5% knew at least 10% of the abbreviations, and no one knew them all. Ninety-two per cent of respondents admitted to searching online for the meanings of abbreviations, and 59.1% believe abbreviations should be prohibited in medical records. A short online lecture improved the number of respondents answering correctly at least 50% of the time from 1.2% to 42% (Pmedical records and are frequently misinterpreted. Online teaching is a valuable tool for physician education. The majority of respondents believed that misinterpreting abbreviations could negatively impact patient care, and that the use of abbreviations should be prohibited in medical records. Due to low rates of comprehension and negative attitudes towards abbreviations in medical communications, we believe their use should be discouraged. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Jaundice in primary care: a cohort study of adults aged >45 years using electronic medical records.

Science.gov (United States)

Taylor, Anna; Stapley, Sally; Hamilton, William

2012-08-01

Jaundice is a rare but important symptom of malignant and benign conditions. When patients present in primary care, understanding the relative likelihood of different disease processes can help GPs to investigate and refer patients appropriately. To identify and quantify the various causes of jaundice in adults presenting in primary care. Historical cohort study using electronic primary care records. UK General Practice Research Database. Participants (186 814 men and women) aged >45 years with clinical events recorded in primary care records between 1 January 2005 and 31 December 2007. Data were searched for episodes of jaundice and explanatory diagnoses identified within the subsequent 12 months. If no diagnosis was found, the patient's preceding medical record was searched for relevant chronic diseases. From the full cohort, 277 patients had at least one record of jaundice between 1 January 2005 and 31 December 2006. Ninety-two (33%) were found to have bile duct stones; 74 (27%) had an explanatory cancer [pancreatic cancer 34 (12%), cholangiocarcinoma 13 (5%) and other diagnosed primary malignancy 27 (10%)]. Liver disease attributed to excess alcohol explained 26 (9%) and other diagnoses were identified in 24 (9%). Sixty-one (22%) had no diagnosis related to jaundice recorded. Although the most common cause of jaundice is bile duct stones, cancers are present in over a quarter of patients with jaundice in this study, demonstrating the importance of urgent investigation into the underlying cause.

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission.

Science.gov (United States)

Lea, Marianne; Barstad, Ingeborg; Mathiesen, Liv; Mowe, Morten; Molden, Espen

2016-02-01

Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient's actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.

Medical device integration: CIOs must bridge the digital divide between devices and electronic medical records.

Science.gov (United States)

Raths, David

2009-02-01

To get funding approved for medical device integration, ClOs suggest focusing on specific patient safety or staff efficiency pain points. Organizations that make clinical engineering part of their IT team report fewer chain-of-command issues. It also helps IT people understand the clinical goals because the engineering people have been working closely with clinicians for years. A new organization has formed to work on collaboration between clinical engineers and IT professionals. For more information, go to www.ceitcollaboration.org. ECRI Institute has written a guide to handling the convergence of medical technology and hospital networks. Its "Medical Technology for the IT Professional: An Essential Guide for Working in Today's Healthcare Setting" also details how IT professionals can assist hospital technology planning and acquisition, and provide ongoing support for IT-based medical technologies. For more information, visit www.ecri.org/ITresource.

Medical Guidelines Presentation and Comparing with Electronic Health Record

Czech Academy of Sciences Publication Activity Database

Veselý, Arnošt; Zvárová, Jana; Peleška, Jan; Buchtela, David; Anger, Z.

2006-01-01

Roč. 75, č. 3-4 (2006), s. 240-245 ISSN 1386-5056 R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : medical guidelines * electronic health record * GLIF model * reminder facility Subject RIV: IN - Informatics, Computer Science Impact factor: 1.726, year: 2006

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.

Brief review: dangers of the electronic medical record

Directory of Open Access Journals (Sweden)

Robbins RA

2015-04-01

Full Text Available EMRs represent a potential boon to patient care and providers, but to date that potential has been unfulfilled. Data suggest that in some instances EMRs may even produce adverse outcomes. This result probably has occurred because lack of provider input and familiarity with EMRs resulting in the medical records becoming less a tool for patient care and more of a tool for documentation and reimbursement.

Evaluating hospital information systems from the point of view of the medical records section users in Medical-Educational Hospitals of Kermanshah 2014.

Science.gov (United States)

Rostami, S; Sarmad, A; Mohammadi, M; Cheleie, M; Amiri, S; Zardoei Golanbary, S H

2015-01-01

Evaluating hospital information systems leads to the improvement and devotion based on the users' needs, especially the medical records section users in hospitals, which are in contact with this system from the moment the patient enters the hospital until his/ her release and after that. The present research aimed to evaluate the hospital information systems from the point of view of the medical record section employees. Materials and method : The current research was applicative-descriptive analytical and the research society included 70 users of the medical history section in the educational-medical centers of Kermanshah city. The data-gathering tool was the 10th part of 9241/ 10 Isometric standard questionnaire of evaluating hospital information systems, with 75 specific questions in 7 bases, with the five spectra Likertt scale, its conceptual admissibility being confirmed in previous researches. 22 SPSS statistical software analyzed its permanency in the present study, which was also confirmed by Cronbach's's alpha test, which equaled to 0.89, and the data. Findings : The highest level of the employees' satisfaction, based on gained scores median, was respectively the incompatibility with the users' expectations, measuring 3.55, self-description measuring 3.54 and controllability - 3.51, which in total presented the average scores of 3.39, the lowest level of satisfaction being related to useful learning , whose value was 3.19. Discussion and conclusion : Hospital information systems' users believe that it is more desirable that the existing systems are based on the measures and consider them proper for making them non-governmental and useful for undesired learning. Considering the long distance of the existing information systems with the desired performance, it is essential that "these systems pay more attention to a more complete and deeper recognition and awareness of users' opinions and requirements in their road. The movement and development is to

A New Electronic Monitoring Device to Measure Medication Adherence: Usability of the Helping Hand™

Directory of Open Access Journals (Sweden)

Sabina De Geest

2010-03-01

Full Text Available The aim of this study was to test the user performance, satisfaction and acceptability of the Helping Hand™ (B&O Medicom electronic medication adherence monitor. Using a mixed-method design, we studied 11 kidney transplant patients and 10 healthy volunteers during three weeks. Although testing showed positive usability aspects, several areas requiring technical improvement were identified: the most important obstacles to usability and acceptability were the weak sound signal, problems loading the medication, and the fact that only one medication could be used at a time.

Privacy Impact Assessment for the Medical and Research Study Records of Human Volunteers

Science.gov (United States)

The Medical & Research Study Records of Human Volunteers System collects demographic and medical information on subjects who participate in research. Learn how this data is collected, used, access to the data, and the purpose of data collection.

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.

Prevalence of Sharing Access Credentials in Electronic Medical Records

Science.gov (United States)

Korach, Tzfania; Shreberk-Hassidim, Rony; Thomaidou, Elena; Uzefovsky, Florina; Ayal, Shahar; Ariely, Dan

2017-01-01

Objectives Confidentiality of health information is an important aspect of the physician patient relationship. The use of digital medical records has made data much more accessible. To prevent data leakage, many countries have created regulations regarding medical data accessibility. These regulations require a unique user ID for each medical staff member, and this must be protected by a password, which should be kept undisclosed by all means. Methods We performed a four-question Google Forms-based survey of medical staff. In the survey, each participant was asked if he/she ever obtained the password of another medical staff member. Then, we asked how many times such an episode occurred and the reason for it. Results A total of 299 surveys were gathered. The responses showed that 220 (73.6%) participants reported that they had obtained the password of another medical staff member. Only 171 (57.2%) estimated how many time it happened, with an average estimation of 4.75 episodes. All the residents that took part in the study (45, 15%) had obtained the password of another medical staff member, while only 57.5% (38/66) of the nurses reported this. Conclusions The use of unique user IDs and passwords to defend the privacy of medical data is a common requirement in medical organizations. Unfortunately, the use of passwords is doomed because medical staff members share their passwords with one another. Strict regulations requiring each staff member to have it's a unique user ID might lead to password sharing and to a decrease in data safety. PMID:28875052

Integration of SNOMED CT into the OpenMRS electronic medical record system framework

CSIR Research Space (South Africa)

Gerber, A

2008-11-01

Full Text Available Integrating a mechanism to store, retrieve and use clinical data with a system to manage medical records enables better utilisation of medical data and improved healthcare. This poster introduces a research project that aims to extend Open...

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

Directory of Open Access Journals (Sweden)

Karlsen Tom H

2004-10-01

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

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

Science.gov (United States)

Robles, Jane

2009-01-01

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

Recording and podcasting of lectures for students of medical school.

Science.gov (United States)

Brunet, Pierre; Cuggia, Marc; Le Beux, Pierre

2011-01-01

Information and communication technology (ICT) becomes an important way for the knowledge transmission, especially in the field of medicine. Podcasting (mobile broadcast content) has recently emerged as an efficient tool for distributing information towards professionals, especially for e-learning contents.The goal of this work is to implement software and hardware tools for collecting medical lectures at its source by direct recording (halls and classrooms) and provide the automatic delivery of these resources for students on different type of devices (computer, smartphone or videogames console). We describe the overall architecture and the methods used by medical students to master this technology in their daily activities. We highlight the benefits and the limits of the Podcast technologies for medical education.

An alternative frame of reference for rehabilitation: the helping process versus the medical model.

Science.gov (United States)

Anderson, T P

1975-03-01

In rehabilitation the frame of reference of the helping professions is significantly different from the standard medical model in the following areas: the dynamics of the relationship, basis for client's trust of the professional, activity versus passivity of both the client and the professional, and the approach to identification and solution of client problems. "The helping process" as practiced in the helping professions is not doing the task, but assisting the client to do it himself, for himself. In this process the needs, values and feelings of both the helper and the helpee must be recognized and dealt with. For the helping process to be successful, three basic conditions are required: development of mutual trust, joint exploration of the problem(s) and listening by both sides. Also involved in attaining success in the helping process is an awareness of not only the barriers in receiving help but also the difficulties in giving help.

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

Science.gov (United States)

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

2016-03-01

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

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

Science.gov (United States)

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

2010-10-01

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

Company project: "Evaluation of the quality of medical records as a tool of clinical risk management"

OpenAIRE

Anna Santa Guzzo; Mario Tecca; Enrico Marinelli; Claudio Bontempi; Caterina Palazzo; Paolo Ursillo; Giuseppe Ferro; Anna Miani; Annunziata Salvati; Stefania Catanzaro; Massimiliano Chiarini; Domenica Vittoria Colamesta; Domenico Cacchio; Patrizia Sposato; Anna Maria Lombardi

2017-01-01

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management, technical and professional issues). The project’s purpose being the promotion of an evaluation and self-evaluation ...

Admission medical records made at night time have the same quality as day and evening time

DEFF Research Database (Denmark)

Amirian, Ilda; Mortensen, Jacob F; Rosenberg, Jacob

2014-01-01

INTRODUCTION: A thorough and accurate admission medical record is an important tool in ensuring patient safety during the hospital stay. Surgeons' performance might be affected during night shifts due to sleep deprivation. The aim of the study was to assess the quality of admission medical records...

Medical guidelines presentation and comparing with Electronic Health Record.

Science.gov (United States)

Veselý, Arnost; Zvárová, Jana; Peleska, Jan; Buchtela, David; Anger, Zdenek

2006-01-01

Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines. The method compares data items on the input of EHR system with medical guidelines GLIF model and is able to reveal if the input data item, that represents patient diagnosis or proposed patient treatment, contradicts with medical guidelines or not. The reminder facility can be part of EHR system itself or it can be realized by a stand-alone reminder system (SRS). The possible architecture of stand-alone reminder system is described in this paper and the advantages of stand-alone solution are discussed. The part of the EHR system could be also a browser that would present graphical GLIF model in easy to understand manner on the user screen. This browser can be data driven and focus attention of user to the relevant part of medical guidelines GLIF model.

The EMR-scan: assessing the quality of Electronic Medical Records in general practice.

NARCIS (Netherlands)

Verheij, R.; Jabaaij, L.; Njoo, K.; Hoogen, H. van den; Bakker, D. de

2008-01-01

Background: The use of electronic medical records (EMR) in general practice has spread rapidly in the last decade (more than 90% today). Traditionally, these records are primarily used for direct patient care and for administrative purposes by the practice involved. In recent years, further

Implementing electronic medical record in family practice in Slovenia and other former Yugoslav Republics: Barriers and requirements

Directory of Open Access Journals (Sweden)

Kolšek Marko

2009-01-01

Full Text Available The author describes problems related to the implementation of electronic medical record in family medicine in Slovenia since 1992 when first personal computers have been delivered to family physicians' practices. The situation of health care informatization and implementation of electronic medical record in primary health care in new countries, other former Yugoslav republics, is described. There are rather big differences among countries and even among some regions of one country, but in the last year the situation improved, especially in Montenegro, Serbia and Slovenia. The main problem that is still unsolved is software offered by several companies which do not offer many functions, are non-standardized or user friendly enough and is not adapted to doctors' needs. Some important questions on medical records are discussed, e.g. what is in fact a medical record, what is its purpose, who uses it, which record is a good one, what should contain and confidentiality issue. The author describes what makes electronic medical record better than paper-based one (above all it is of better quality, efficiency and care-safe, easier in data retrieval and does it offer the possibility of data exchange with other health care professionals and what are the barriers to its wider implementation.

Management of stinging insect hypersensitivity: a 5-year retrospective medical record review.

Science.gov (United States)

Johnson, Thomas; Dietrich, Jeffrey; Hagan, Larry

2006-08-01

The Joint Task Force on Practice Parameters for Allergy and Immunology recommends that patients with a history of a systemic reaction to an insect sting be educated on ways to avoid insect stings, carry injectable epinephrine for emergency self-treatment, undergo specific IgE testing for stinging insect sensitivity, and be considered for immunotherapy. To review frontline providers' documented care and recommendations for imported fire ant and flying insect hypersensitivity reactions. A retrospective medical record review was performed of emergency department and primary care clinic visits between November 1, 1999, and November 30, 2004. Using International Classification of Diseases, Ninth Revision, codes, medical records were selected for review to identify patients with potential insect hypersensitivity. A total of 769 medical records from patients who experienced an insect sting were reviewed. Of 120 patients with a systemic reaction, 66 (55.0%) received a prescription for injectable epinephrine, and 14 (11.7%) were given information regarding avoidance of the offending insect. Forty-seven patients with systemic reactions (39.2%) were referred to an allergist. Of 28 patients who kept their appointments and underwent skin testing, 3 had negative results and 25 (89%) had positive results and were advised to start immunotherapy. Adherence to the stinging insect hypersensitivity practice parameter recommendations is poor. Many patients who have experienced a systemic reaction after an insect sting and have sought medical care are not afforded an opportunity for potentially lifesaving therapy.

Electronic medical records in dermatology: Practical implications

Directory of Open Access Journals (Sweden)

Kaliyadan Feroze

2009-01-01

Full Text Available Background: Electronic medical records (EMRs can be of great use in dermatological data recording. Unfortunately, not many studies have been carried out in this specific area. Aims: We attempt to evaluate the use of an EMR system in dermatology, comparing it with a conventional paper-based system. Methods: Two hundred patient records of patients attending the dermatology outpatient department were studied over a 3-month period. Half the reports were entered in the conventional paper-based format while the other half was entered in an EMR system. The time taken for each consultation was recorded and the same was carried out for the first subsequent follow-up visit. Results: The average time taken for the completion of the EMR-based consultation for new cases was 19.15 min (range, 10-30 min; standard deviation, 6.47. The paper-based consultation had an average time of 15.70 min (range, 5-25 min; standard deviation, 6.78. The P-value (T-test was used was 0.002, which was significant. The average time taken for consultations and entering progress notes in the follow-up cases was slightly less than 10 min (9.7 for EMR while it was slightly more than 10 min (10.3 for the paper format. The difference was not statistically significant. The doctors involved also mentioned what they felt were the advantages and disadvantages of the system along with suggestions for improvement. Conclusion: The use of an EMR system in dermatology (or for that matter in any specialty may overawe most users at the beginning, but once a comfort level is established, EMR is likely to outscore conventional paper recording systems. More time-motion-case studies are required to ascertain the optimal usage of EMR systems.

Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases

Directory of Open Access Journals (Sweden)

Fathelrahman Ahmed I

2009-09-01

Full Text Available Abstract Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed.

Training and development needs of medical record staff at the Korle ...

African Journals Online (AJOL)

Ghana Library Journal ... Though the medical record services play an important role in health care delivery, indications are that the ... This neglect has far reaching implications for the quality of service required from the Ghana Health Service.

Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area.

Science.gov (United States)

Economou, Marina; Bergiannaki, Joanna Despina; Peppou, Lily Evangelia; Karayanni, Ismini; Skalkotos, George; Patelakis, Athanasios; Souliotis, Kyriakos; Stefanis, Costas

2016-05-01

The financial crisis has yielded adverse effects on the population worldwide, as evidenced by elevated rates of major depression. International recommendations for offsetting the mental health impact of the recession highlight the need for effective treatment, including reduction in the stigma attached to the disorder. This study endeavoured to explore lay attitudes to depression and psychiatric medication during a period of financial crisis and to identify their correlates. Furthermore, it investigated their link to help-seeking intentions. A random and representative sample of 621 respondents from Athens area participated in the study (Response Rate = 81.7%). The telephone interview schedule consisted of the Personal Stigma Scale, a self-constructed scale tapping attitudes to psychiatric medication and one question addressing help-seeking intentions. The preponderant stigmatising belief about depression pertains to perceiving the disorder as a sign of personal weakness. In addition, stereotypes of unpredictability and dangerousness were popular among the sample. Nonetheless, stigmatising beliefs are much stronger with regard to psychiatric medication; perceived as addictive, capable of altering one's personality, less effective than homeopathic remedies and doing more harm than good. Help-seeking intentions were predicted by education, unemployment and attitudes to psychiatric medication solely. Research on the mental health effects of the global recession should encompass studies investigating the stigma attached to mental disorders and its implications. © The Author(s) 2016.

Formalized Medical Guidelines and a Structured Electronic Health Record.

Czech Academy of Sciences Publication Activity Database

Peleška, Jan; Anger, Z.; Buchtela, David; Šebesta, K.; Tomečková, Marie; Veselý, Arnošt; Zvára, K.; Zvárová, Jana

2005-01-01

Roč. 11, - (2005), s. 4652-4656 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 : formalization of guidelines in cardilogy * GLIF model * structure electronic health record * algorithm in cardiovascular diagnostics and treatment Subject RIV: BD - Theory of Information

Job characteristic perception and intrinsic motivation in medical record department staff.

Science.gov (United States)

Isfahani, Sakineh Saghaeiannejad; Bahrami, Soosan; Torki, Sedighe

2013-01-01

Human resources are key factors in service organizations like hospitals. Therefore, motivating human recourses to achieve the objectives of an organization is important. Job enrichment is a strategy used to increase job motivation in staffs. The goal of the current study is to determine the relationship between job characteristics and intrinsic motivation in medical record staff in hospitals related to Medical Science University in Isfahan in 2011-2012 academic year. The type of the study is descriptive and corelational of multi variables. The population of the study includes all the medical record staffs of medical record department working in Medical Science hospitals of Isfahan. One hundred twentyseven subjects were selected by conducting a census. In the present study, data collected by using two questionnaires of job characteristics devised by Hackman and Oldeham, and of intrinsic motivation. Content validity was confirmed by experts and its reliability was calculated through coefficient of Cronbach's alpha (r1 = 0.84- r2 = 0.94). The questionnaires completed were entered into SPSS(18) software; furthermore, statistical analysis done descriptively (frequency percent, mean, standard deviation, Pierson correlation coefficient,...) and inferentially (multiple regression, MANOVA, LSD). A significant relationship between job characteristics as well as its elements (skill variety, task identity, task significance, autonomy and feedback) and intrinsic motivation was noticed. (p intrinsic motivation was significant and job feedback had the most impact upon the intrinsic motivation. No significant difference was noticed among the mean amounts of job characteristic perception according to age, gender, level of education, and the kind of educational degree in hospitals. However, there was a significant difference among the mean amounts of job characteristic perception according to the unit of service and the years of servicein hospitals. The findings show that all job

Natural Language Processing Based Instrument for Classification of Free Text Medical Records

Directory of Open Access Journals (Sweden)

Manana Khachidze

2016-01-01

Full Text Available According to the Ministry of Labor, Health and Social Affairs of Georgia a new health management system has to be introduced in the nearest future. In this context arises the problem of structuring and classifying documents containing all the history of medical services provided. The present work introduces the instrument for classification of medical records based on the Georgian language. It is the first attempt of such classification of the Georgian language based medical records. On the whole 24.855 examination records have been studied. The documents were classified into three main groups (ultrasonography, endoscopy, and X-ray and 13 subgroups using two well-known methods: Support Vector Machine (SVM and K-Nearest Neighbor (KNN. The results obtained demonstrated that both machine learning methods performed successfully, with a little supremacy of SVM. In the process of classification a “shrink” method, based on features selection, was introduced and applied. At the first stage of classification the results of the “shrink” case were better; however, on the second stage of classification into subclasses 23% of all documents could not be linked to only one definite individual subclass (liver or binary system due to common features characterizing these subclasses. The overall results of the study were successful.

Men with pelvic pain: perceived helpfulness of medical and self-management strategies.

Science.gov (United States)

Turner, Judith A; Ciol, Marcia A; Von Korff, Michael; Liu, Yung-Wen; Berger, Richard

2006-01-01

To assess the frequency of use of different treatments and pain management strategies and their perceived helpfulness in male patients with pelvic pain. Approximately 1 month after a health maintenance organization visit for pelvic pain, 286 men (mean age 46.7 years) completed telephone interviews about their symptoms and treatments and pain management strategies used in the past year. Participants rated the helpfulness of each treatment and strategy used on 0 to 10 scales. Even though men with identified bacterial etiology were excluded from the study, antibiotic medication was the most commonly reported treatment (67% of patients) and rated as the second most helpful treatment [mean (SD)=6.3 (3.6)]. Opiates were rated as the most helpful treatment on average [mean (SD)=7.9 (2.1)], but were used by only 12% of patients. Substantial minorities of patients reported several behaviors as helpful, including urinating (reported as helpful by 26%), taking warm baths (23%), and drinking water (23%), although patterns of effects differed for men with versus without urinary symptoms. Activities most commonly reported as worsening symptoms were sitting (42%), walking/jogging (27%), and sexual activity (25%). Patients with male pelvic pain syndrome are commonly prescribed antibiotics, which they perceive as moderately helpful, despite the lack of scientific evidence of efficacy. Clinicians may find it useful to support patient use of safe, inexpensive, self-management approaches, especially warm baths, increased water intake, and avoidance of prolonged sitting.

Adding Live-Streaming to Recorded Lectures in a Non-Distributed Pre-Clerkship Medical Education Model.

Science.gov (United States)

Sandhu, Amanjot; Fliker, Aviva; Leitao, Darren; Jones, Jodi; Gooi, Adrian

2017-01-01

Live-streaming video has had increasing uses in medical education, especially in distributed education models. The literature on the impact of live-streaming in non-distributed education models, however, is scarce. To determine the attitudes towards live-streaming and recorded lectures as a resource to pre-clerkship medical students in a non-distributed medical education model. First and second year medical students were sent a voluntary cross-sectional survey by email, and were asked questions on live-streaming, recorded lectures and in person lectures using a 5-point Likert and open answers. Of the 118 responses (54% response rate), the data suggested that both watching recorded lectures (Likert 4.55) and live-streaming lectures (4.09) were perceived to be more educationally valuable than face-to-face attendance of lectures (3.60). While responses indicated a statistically significant increase in anticipated classroom attendance if both live-streaming and recorded lectures were removed (from 63% attendance to 76%, p =0.002), there was no significant difference in attendance if live-streaming lectures were removed but recorded lectures were maintained (from 63% to 66%, p=0.76). The addition of live-streaming lectures in the pre-clerkship setting was perceived to be value added to the students. The data also suggests that the removal of live-streaming lectures would not lead to a statistically significant increase in classroom attendance by pre-clerkship students.

Identifying risk factors for healthcare-associated infections from electronic medical record home address data

Directory of Open Access Journals (Sweden)

Rosenman Marc B

2010-09-01

Full Text Available Abstract Background Residential address is a common element in patient electronic medical records. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA infections. Residential addresses may be useful for identifying patients residing in healthcare-associated settings, but methods for categorizing residence type based on electronic medical records have not been widely documented. The aim of this study was to develop a process to assist in differentiating healthcare-associated from community-associated MRSA infections by analyzing patient addresses to determine if residence reported at the time of positive culture was associated with a healthcare facility or other institutional location. Results We identified 1,232 of the patients (8.24% of the sample with positive cultures as probable cases of healthcare-associated MRSA based on residential addresses contained in electronic medical records. Combining manual review with linking to institutional address databases improved geocoding rates from 11,870 records (79.37% to 12,549 records (83.91%. Standardization of patient home address through geocoding increased the number of matches to institutional facilities from 545 (3.64% to 1,379 (9.22%. Conclusions Linking patient home address data from electronic medical records to institutional residential databases provides useful information for epidemiologic researchers, infection control practitioners, and clinicians. This information, coupled with other clinical and laboratory data, can be used to inform differentiation of healthcare-acquired from community-acquired infections. The process presented should be extensible with little or no added data costs.

A primer on endoscopic electronic medical records.

Science.gov (United States)

Atreja, Ashish; Rizk, Maged; Gurland, Brooke

2010-02-01

Endoscopic electronic medical record systems (EEMRs) are now increasingly utilized in many endoscopy centers. Modern EEMRs not only support endoscopy report generation, but often include features such as practice management tools, image and video clip management, inventory management, e-faxes to referring physicians, and database support to measure quality and patient outcomes. There are many existing software vendors offering EEMRs, and choosing a software vendor can be time consuming and confusing. The goal of this article is inform the readers about current functionalities available in modern EEMR and provide them with a framework necessary to find an EEMR that is best fit for their practice.

How to limit the burden of data collection for Quality Indicators based on medical records? The COMPAQH experience

Directory of Open Access Journals (Sweden)

Grenier Catherine

2008-10-01

Full Text Available Abstract Background Our objective was to limit the burden of data collection for Quality Indicators (QIs based on medical records. Methods The study was supervised by the COMPAQH project. Four QIs based on medical records were tested: medical record conformity; traceability of pain assessment; screening for nutritional disorders; time elapsed before sending copy of discharge letter to the general practitioner. Data were collected by 6 Clinical Research Assistants (CRAs in a panel of 36 volunteer hospitals and analyzed by COMPAQH. To limit the burden of data collection, we used the same sample of medical records for all 4 QIs, limited sample size to 80 medical records, and built a composite score of only 10 items to assess medical record completeness. We assessed QI feasibility by completing a grid of 19 potential problems and evaluating time spent. We assessed reliability (κ coefficient as well as internal consistency (Cronbach α coefficient in an inter-observer study, and discriminatory power by analysing QI variability among hospitals. Results Overall, 23 115 data items were collected for the 4 QIs and analyzed. The average time spent on data collection was 8.5 days per hospital. The most common feasibility problem was misunderstanding of the item by hospital staff. QI reliability was good (κ: 0.59–0.97 according to QI. The hospitals differed widely in their ability to meet the quality criteria (mean value: 19–85%. Conclusion These 4 QIs based on medical records can be used to compare the quality of record keeping among hospitals while limiting the burden of data collection, and can therefore be used for benchmarking purposes. The French National Health Directorate has included them in the new 2009 version of the accreditation procedure for healthcare organizations.

Secure and Trustable Electronic Medical Records Sharing using Blockchain

OpenAIRE

Dubovitskaya, Alevtina; Xu, Zhigang; Ryu, Samuel; Schumacher, Michael; Wang, Fusheng

2017-01-01

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthc...

A Qualitative Exploration of the Help-Seeking Behaviors of Students Who Experience Psychological Distress Around Assessment at Medical School.

Science.gov (United States)

Winter, Rachel I; Patel, Rakesh; Norman, Robert I

2017-08-01

Medical students are at high risk of experiencing psychological distress at medical school and developing mental ill-health during professional practice. Despite efforts by faculty to raise awareness about this risk, many students choose to suffer in silence in the face of psychological distress. The aim of this study was to explore drivers that prompted help-seeking behavior and barriers that prevented individuals prioritizing their well-being around the time of high-stakes assessment at medical school. Semi-structured interviews were conducted with fifty-seven students who failed high-stakes assessment at two UK medical schools, exploring their experience of academic difficulty and perceptions about causes. A thematic analysis of twenty transcripts that met inclusion criteria was completed to identify key factors that influenced participants' decisions around seeking help for their psychological distress, and in some cases, mental health problems. Twenty participants who specifically described a deterioration in their mental health around the time of assessment were included in this study. Barriers to seeking help in these instances included: normalization of symptoms or situation; failure to recognize a problem existed; fear of stigmatisation; overt symptoms of mental distress; and misconceptions about the true nature of the medical school, for example beliefs about a punitive response from the school if they failed. Drivers for seeking help appropriately included: building trust with someone in order to confide in them later on, and self-awareness about the need to maintain good mental health. There are various drivers and barriers for students' help seeking behaviors when experiencing psychological distress around the time of assessment, particularly self-awareness about the problem and prioritisation of well-being. Students who fail to recognize their own deteriorating mental health are at risk of academic failure and medical schools need to develop

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

Energy Technology Data Exchange (ETDEWEB)

Diener, T [Cleveland State University, Cleveland, OH (United States); Wilkinson, D [Cleveland Clinic Foundation, Cleveland, OH (United States)

2016-06-15

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

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

NARCIS (Netherlands)

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

2015-01-01

To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. We included patients 65 years and older who received NSAIDs between

Quality of co-prescribing NSAID and gastroprotective medications for elders in The Netherlands and its association with the electronic medical record.

NARCIS (Netherlands)

Opondo, D.; Visscher, S.; Eslami, S.; Verheij, R.A.; Korevaar, J.C.; Abu-Hanna, A.

2015-01-01

Objective: To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. Methods: We included patients 65 years and older who

A systematic review of the factors associated with delays in medical and psychological help-seeking among men.

Science.gov (United States)

Yousaf, Omar; Grunfeld, Elizabeth A; Hunter, Myra S

2015-01-01

Despite a growing literature on the factors associated with men's low rates of medical and psychological help-seeking, a systematic review of these is missing. Such an overview can help to inform health psychologists of the barriers to the performance of adaptive health behaviours, such as prompt help-seeking, and could inform theoretical advancements and the development of targeted interventions to facilitate prompt help-seeking among men. We systematically reviewed quantitative and qualitative empirical papers on factors associated with delays in men's medical and psychological help-seeking. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and we used the databases PsycINFO, Medline, Embase and PsycARTICLES (with keywords: men/male*/gender*, help*/seek* and health*/service*/utili*[sation]) for papers in English. 41 citations (amounting to 21,787 participants aged 15-80 + ) met the inclusion criteria. Approximately half of these used qualitative methodologies (i.e., semi-structured interviews and focus groups), while half used quantitative methodologies (i.e., questionnaires). We identify a number of recurring cognitive, emotional, health-service related and socio-demographic help-seeking factors/predictors from the 41 papers. Of these, the most prominent barriers to help-seeking were disinclination to express emotions/concerns about health, embarrassment, anxiety and fear, and poor communication with health-care professionals.

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

Science.gov (United States)

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.

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.

Managing Costs and Medical Information

Science.gov (United States)

People with cancer may face major financial challenges and need help dealing with the high costs of care. Cancer treatment can be very expensive, even when you have insurance. Learn ways to manage medical information, paperwork, bills, and other records.

Laypersons can seek help from their Facebook friends regarding medical diagnosis

DEFF Research Database (Denmark)

Folkestad, Lars; Brodersen, Jacob Broder; Hallas, Peter

2011-01-01

INTRODUCTION: In contrast to Internet search engines, social media on the Internet such as Facebook, Twitter, etc. reach a large number of people, who are ready to help answering questions. This type of information aggregation has been dubbed "crowdsourcing" i.e. outsourcing a task to a large group...... of people or community (a crowd) through an open call. Our aim was to explore whether laypersons via Facebook friends could crowd source their way to a medical diagnosis based on a brief medical history, posted as a status update on Facebook. MATERIAL AND METHODS: The participants posted a brief case story...... to very silly diagnostic suggestions. CONCLUSION: Based on this study, we believe that laypersons can use his or her »Facebook friends" to identify the need to see a doctor for their symptoms rather than relying on them to give them a specific diagnosis for their symptoms....

29 CFR 1913.10 - Rules of agency practice and procedure concerning OSHA access to employee medical records.

Science.gov (United States)

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Rules of agency practice and procedure concerning OSHA... PRACTICE AND PROCEDURE CONCERNING OSHA ACCESS TO EMPLOYEE MEDICAL RECORDS § 1913.10 Rules of agency practice and procedure concerning OSHA access to employee medical records. (a) General policy. OSHA access...

Going Online: Helping Technical Communicators Help Translators.

Science.gov (United States)

Flint, Patricia; Lord van Slyke, Melanie; Starke-Meyerring, Doreen; Thompson, Aimee

1999-01-01

Explains why technical communicators should help translators. Offers tips for creating "translation-friendly" documentation. Describes the research and design process used by the authors to create an online tutorial that provides technical communicators at a medical technology company the information they need to help them write and…

Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: The significance of early rapid response.

Science.gov (United States)

Grilo, Carlos M; White, Marney A; Masheb, Robin M; Gueorguieva, Ralitza

2015-04-01

We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings. One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes. Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss. Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED. clinicaltrials.gov: NCT00537810 (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Does the Use of a Checklist Help Medical Students in the Detection of Abnormalities on a Chest Radiograph?

Science.gov (United States)

Kok, Ellen M; Abed, Abdelrazek; Robben, Simon G F

2017-12-01

The interpretation of chest radiographs is a complex task that is prone to diagnostic error, especially for medical students. The aim of this study is to investigate the extent to which medical students benefit from the use of a checklist regarding the detection of abnormalities on a chest radiograph. We developed a checklist based on literature and interviews with experienced thorax radiologists. Forty medical students in the clinical phase assessed 18 chest radiographs during a computer test, either with (n = 20) or without (n = 20) the checklist. We measured performance and asked participants for feedback using a survey. Participants that used a checklist detected more abnormalities on images with multiple abnormalities (M = 50.1%) than participants that could not use a checklist (M = 41.9%), p = 0.04. The post-experimental survey shows that on average, participants considered the checklist helpful (M = 3.25 on a five-point scale), but also time consuming (M = 3.30 on a five-point scale). In conclusion, a checklist can help medical students to detect abnormalities in chest radiographs. Moreover, students tend to appreciate the use of a checklist as a helpful tool during the interpretation of a chest radiograph. Therefore, a checklist is a potentially important tool to improve radiology education in the medical curriculum.

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…

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

DEFF Research Database (Denmark)

Bertelsen, Pernille; Nøhr, Christian

2005-01-01

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

Missing medical records: an obstacle to archival survey-research in a rural community in South Africa

Directory of Open Access Journals (Sweden)

L. Wegner

2013-12-01

Full Text Available Keeping good quality medical records is an essential yet oftenneglected part of a health-care practitioner’s workload. In South Africa, by lawall health care facilities are required to retain medical records for a minimum ofsix years after the cessation of a patient’s treatment. In an archival survey thatwas attempted in a rural community in South Africa, only 39% of the recordsthat were requested were located. The procedure that was followed in order toobtain the records to be included in the survey is briefly described in this paper,highlighting the challenges experienced in four district hospitals in this community.The phenomenon has serious implications not only for the quality of healthcare,incidence of iatrogenic injuries and the future of the health-care practitioner’s career, but it also impacts on the ability to conductresearch to inform practice. An aspect that is not often considered is the impact of poor record keeping on the research and teachingcomponent of the broader medical profession.

Computational Diagnostic: A Novel Approach to View Medical Data.

Energy Technology Data Exchange (ETDEWEB)

Mane, K. K. (Ketan Kirtiraj); Börner, K. (Katy)

2007-01-01

A transition from traditional paper-based medical records to electronic health record is largely underway. The use of electronic records offers tremendous potential to personalize patient diagnosis and treatment. In this paper, we discuss a computational diagnostic tool that uses digital medical records to help doctors gain better insight about a patient's medical condition. The paper details different interactive features of the tool which offer potential to practice evidence-based medicine and advance patient diagnosis practices. The healthcare industry is a constantly evolving domain. Research from this domain is often translated into better understanding of different medical conditions. This new knowledge often contributes towards improved diagnosis and treatment solutions for patients. But the healthcare industry lags behind to seek immediate benefits of the new knowledge as it still adheres to the traditional paper-based approach to keep track of medical records. However recently we notice a drive that promotes a transition towards electronic health record (EHR). An EHR stores patient medical records in digital format and offers potential to replace the paper health records. Earlier attempts of an EHR replicated the paper layout on the screen, representation of medical history of a patient in a graphical time-series format, interactive visualization with 2D/3D generated images from an imaging device. But an EHR can be much more than just an 'electronic view' of the paper record or a collection of images from an imaging device. In this paper, we present an EHR called 'Computational Diagnostic Tool', that provides a novel computational approach to look at patient medical data. The developed EHR system is knowledge driven and acts as clinical decision support tool. The EHR tool provides two visual views of the medical data. Dynamic interaction with data is supported to help doctors practice evidence-based decisions and make judicious

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

Science.gov (United States)

Brandes, Susan; Wells, Karen; Bandy, Margaret

2013-01-01

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

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

Science.gov (United States)

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

2016-12-01

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

Paper versus computer: Feasibility of an electronic medical record in general pediatrics

NARCIS (Netherlands)

J. Roukema (Jolt); R.K. Los (Renske); S.E. Bleeker (Sacha); A.M. van Ginneken (Astrid); J. van der Lei (Johan); H.A. Moll (Henriëtte)

2006-01-01

textabstractBACKGROUND. Implementation of electronic medical record systems promises significant advances in patient care, because such systems enhance readability, availability, and data quality. Structured data entry (SDE) applications can prompt for completeness, provide greater accuracy and

Mining free-text medical records for companion animal enteric syndrome surveillance.

Science.gov (United States)

Anholt, R M; Berezowski, J; Jamal, I; Ribble, C; Stephen, C

2014-03-01

Large amounts of animal health care data are present in veterinary electronic medical records (EMR) and they present an opportunity for companion animal disease surveillance. Veterinary patient records are largely in free-text without clinical coding or fixed vocabulary. Text-mining, a computer and information technology application, is needed to identify cases of interest and to add structure to the otherwise unstructured data. In this study EMR's were extracted from veterinary management programs of 12 participating veterinary practices and stored in a data warehouse. Using commercially available text-mining software (WordStat™), we developed a categorization dictionary that could be used to automatically classify and extract enteric syndrome cases from the warehoused electronic medical records. The diagnostic accuracy of the text-miner for retrieving cases of enteric syndrome was measured against human reviewers who independently categorized a random sample of 2500 cases as enteric syndrome positive or negative. Compared to the reviewers, the text-miner retrieved cases with enteric signs with a sensitivity of 87.6% (95%CI, 80.4-92.9%) and a specificity of 99.3% (95%CI, 98.9-99.6%). Automatic and accurate detection of enteric syndrome cases provides an opportunity for community surveillance of enteric pathogens in companion animals. Copyright © 2014 Elsevier B.V. All rights reserved.

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.

History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population.

Science.gov (United States)

Rocca, Walter A; Yawn, Barbara P; St Sauver, Jennifer L; Grossardt, Brandon R; Melton, L Joseph

2012-12-01

The Rochester Epidemiology Project (REP) has maintained a comprehensive medical records linkage system for nearly half a century for almost all persons residing in Olmsted County, Minnesota. Herein, we provide a brief history of the REP before and after 1966, the year in which the REP was officially established. The key protagonists before 1966 were Henry Plummer, Mabel Root, and Joseph Berkson, who developed a medical records linkage system at Mayo Clinic. In 1966, Leonard Kurland established collaborative agreements with other local health care providers (hospitals, physician groups, and clinics [primarily Olmsted Medical Center]) to develop a medical records linkage system that covered the entire population of Olmsted County, and he obtained funding from the National Institutes of Health to support the new system. In 1997, L. Joseph Melton III addressed emerging concerns about the confidentiality of medical record information by introducing a broad patient research authorization as per Minnesota state law. We describe how the key protagonists of the REP have responded to challenges posed by evolving medical knowledge, information technology, and public expectation and policy. In addition, we provide a general description of the system; discuss issues of data quality, reliability, and validity; describe the research team structure; provide information about funding; and compare the REP with other medical information systems. The REP can serve as a model for the development of similar research infrastructures in the United States and worldwide. Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Cinemeducation: A pilot student project using movies to help students learn medical professionalism.

Science.gov (United States)

Lumlertgul, Nuttha; Kijpaisalratana, Naruchorn; Pityaratstian, Nuttorn; Wangsaturaka, Danai

2009-07-01

Using movies has been accepted worldwide as a tool to help students learn medical professionalism. In the second year, a group of medical students conducted the "Cinemeducation" project to promote professionalism in the "Medical Ethics and Critical Thinking" course. Five movies with professionalism issues were screened with 20-30 students attending each session. After the show, participants then were asked to reflect on what they had learned in terms of professionalism. Two students led group discussion emphasizing questioning and argumentation for 60 min. Additional learning issues emerging from each session were also explored in more depth and arranged into a report. In the Cinemeducation Project, medical students have learned five main ethical issues in each film, which were the doctor-patient relationship, informed consent and clinical trials in patients, management of genetic disorders, patient management, and brain death and organ transplantation. In addition to issues of professionalism, they also developed critical thinking and moral reasoning skills. Using a case-based scenario in movies has proven to be an effective and entertaining method of facilitating students with learning on professionalism.

29 CFR 1910.1020 - Access to employee exposure and medical records.

Science.gov (United States)

2010-07-01

... concerning the protection of trade secret information. (b) Scope and application. (1) This section applies to... using exposure or medical records means any compilation of data or any statistical study based at least... methodology (sampling plan), a description of the analytical and mathematical methods used, and a summary of...

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

Science.gov (United States)

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

2015-08-01

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

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

Directory of Open Access Journals (Sweden)

Clara Carpeggiani

2015-08-01

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

Enhancing Student Empathetic Engagement, History-Taking, and Communication Skills During Electronic Medical Record Use in Patient Care.

Science.gov (United States)

LoSasso, Alisa Alfonsi; Lamberton, Courtney E; Sammon, Mary; Berg, Katherine T; Caruso, John W; Cass, Jonathan; Hojat, Mohammadreza

2017-07-01

To examine whether an intervention on proper use of electronic medical records (EMRs) in patient care could help improve medical students' empathic engagement, and to test the hypothesis that the training would reduce communication hurdles in clinical encounters. Seventy third-year medical students from the Sidney Kimmel Medical College at Thomas Jefferson University were randomly divided into intervention and control groups during their six-week pediatric clerkship in 2012-2013. The intervention group received a one-hour training session on EMR-specific communication skills, including discussion of EMR use, the SALTED mnemonic and technique (Set-up, Ask, Listen, Type, Exceptions, Documentation), and role-plays. Both groups completed the Jefferson Scale of Empathy (JSE) at the clerkship's start and end. At clerkship's end, faculty and standardized patients (SPs) rated students' empathic engagement in SP encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and their history-taking and communication skills. Faculty mean ratings on the JSPPPE, history-taking skills, and communication skills were significantly higher for the intervention group than the control group. SP mean ratings on history-taking skills were significantly higher for the intervention group than the control group. Both groups' JSE mean scores increased pretest to posttest, but the changes were not significant. The intervention group's posttest JSE mean score was higher than the control group's, but the difference was not significant. The findings suggest that a simple intervention providing specialized training in EMR-specific communication can improve medical students' empathic engagement in patient care, history-taking skills, and communication skills.

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

Science.gov (United States)

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

2010-01-01

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

A SWOT Analysis of the Various Backup Scenarios Used in Electronic Medical Record Systems.

Science.gov (United States)

Seo, Hwa Jeong; Kim, Hye Hyeon; Kim, Ju Han

2011-09-01

Electronic medical records (EMRs) are increasingly being used by health care services. Currently, if an EMR shutdown occurs, even for a moment, patient safety and care can be seriously impacted. Our goal was to determine the methodology needed to develop an effective and reliable EMR backup system. Our "independent backup system by medical organizations" paradigm implies that individual medical organizations develop their own EMR backup systems within their organizations. A "personal independent backup system" is defined as an individual privately managing his/her own medical records, whereas in a "central backup system by the government" the government controls all the data. A "central backup system by private enterprises" implies that individual companies retain control over their own data. A "cooperative backup system among medical organizations" refers to a networked system established through mutual agreement. The "backup system based on mutual trust between an individual and an organization" means that the medical information backup system at the organizational level is established through mutual trust. Through the use of SWOT analysis it can be shown that cooperative backup among medical organizations is possible to be established through a network composed of various medical agencies and that it can be managed systematically. An owner of medical information only grants data access to the specific person who gave the authorization for backup based on the mutual trust between an individual and an organization. By employing SWOT analysis, we concluded that a linkage among medical organizations or between an individual and an organization can provide an efficient backup system.

Automatic prediction of rheumatoid arthritis disease activity from the electronic medical records.

Directory of Open Access Journals (Sweden)

Chen Lin

Full Text Available We aimed to mine the data in the Electronic Medical Record to automatically discover patients' Rheumatoid Arthritis disease activity at discrete rheumatology clinic visits. We cast the problem as a document classification task where the feature space includes concepts from the clinical narrative and lab values as stored in the Electronic Medical Record.The Training Set consisted of 2792 clinical notes and associated lab values. Test Set 1 included 1749 clinical notes and associated lab values. Test Set 2 included 344 clinical notes for which there were no associated lab values. The Apache clinical Text Analysis and Knowledge Extraction System was used to analyze the text and transform it into informative features to be combined with relevant lab values.Experiments over a range of machine learning algorithms and features were conducted. The best performing combination was linear kernel Support Vector Machines with Unified Medical Language System Concept Unique Identifier features with feature selection and lab values. The Area Under the Receiver Operating Characteristic Curve (AUC is 0.831 (σ = 0.0317, statistically significant as compared to two baselines (AUC = 0.758, σ = 0.0291. Algorithms demonstrated superior performance on cases clinically defined as extreme categories of disease activity (Remission and High compared to those defined as intermediate categories (Moderate and Low and included laboratory data on inflammatory markers.Automatic Rheumatoid Arthritis disease activity discovery from Electronic Medical Record data is a learnable task approximating human performance. As a result, this approach might have several research applications, such as the identification of patients for genome-wide pharmacogenetic studies that require large sample sizes with precise definitions of disease activity and response to therapies.

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

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Daniels, Cheryl Andrea

2013-01-01

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

Medical records confidentiality and public health research: two values at stake? An italian survey focus on individual preferences

Directory of Open Access Journals (Sweden)

Virgilia Toccaceli

2015-02-01

Full Text Available In a time when Europe is preparing to introduce new regulations on privacy protection, we conducted a survey among 1700 twins enrolled in the Italian Twin Register about the access and use of their medical records for public health research without explicit informed consent. A great majority of respondents would refuse or are doubtful about the access and use of hospital discharge records or clinical data without their explicit consent. Young and female individuals represent the modal profile of these careful people. As information retrieved from medical records is crucial for progressing knowledge, it is important to promote a better understanding of the value of public health research activities among the general population. Furthermore, public opinions are relevant to policy making, and concerns and preferences about privacy and confidentiality in research can contribute to the design of procedures to exploit medical records effectively and customize the protection of individuals’ medical data.

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

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Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

2015-06-01

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

Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature

NARCIS (Netherlands)

Simons, S.M.; Cillessen, F.H.J.M.; Hazelzet, J.A.

2016-01-01

BACKGROUND: A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing

Consistency in performance evaluation reports and medical records.

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Lu, Mingshan; Ma, Ching-to Albert

2002-12-01

In the health care market managed care has become the latest innovation for the delivery of services. For efficient implementation, the managed care organization relies on accurate information. So clinicians are often asked to report on patients before referrals are approved, treatments authorized, or insurance claims processed. What are clinicians responses to solicitation for information by managed care organizations? The existing health literature has already pointed out the importance of provider gaming, sincere reporting, nudging, and dodging the rules. We assess the consistency of clinicians reports on clients across administrative data and clinical records. For about 1,000 alcohol abuse treatment episodes, we compare clinicians reports across two data sets. The first one, the Maine Addiction Treatment System (MATS), was an administrative data set; the state government used it for program performance monitoring and evaluation. The second was a set of medical record abstracts, taken directly from the clinical records of treatment episodes. A clinician s reporting practice exhibits an inconsistency if the information reported in MATS differs from the information reported in the medical record in a statistically significant way. We look for evidence of inconsistencies in five categories: admission alcohol use frequency, discharge alcohol use frequency, termination status, admission employment status, and discharge employment status. Chi-square tests, Kappa statistics, and sensitivity and specificity tests are used for hypothesis testing. Multiple imputation methods are employed to address the problem of missing values in the record abstract data set. For admission and discharge alcohol use frequency measures, we find, respectively, strong and supporting evidence for inconsistencies. We find equally strong evidence for consistency in reports of admission and discharge employment status, and mixed evidence on report consistency on termination status. Patterns of

A retrospective cohort study on lifestyle habits of cardiovascular patients: how informative are medical records?

NARCIS (Netherlands)

Fouwels, Annemarie J.; Bredie, Sebastiaan J. H.; Wollersheim, Hub; Schippers, Gerard M.

2009-01-01

ABSTRACT: BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of

A retrospective cohort study on lifestyle habits of cardiovascular patients: how informative are medical records?

NARCIS (Netherlands)

Fouwels, A.J.; Bredie, S.J.H.; Wollersheim, H.C.H.; Schippers, G.M.

2009-01-01

BACKGROUND: To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medical records versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of the

Barriers to retrieving patient information from electronic health record data: failure analysis from the TREC Medical Records Track.

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Edinger, Tracy; Cohen, Aaron M; Bedrick, Steven; Ambert, Kyle; Hersh, William

2012-01-01

Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems.

Applying the theory of constraints to the logistics service of medical records of a hospital

Directory of Open Access Journals (Sweden)

Víctor-G. Aguilar-Escobar

2016-09-01

Full Text Available Management of patient records in a hospital is of major importance, for its impact both on the quality of care and on the associated costs. Since this process is circular, the prevention of the building up of bottlenecks is especially important. Thus, the objective of this paper was to analyze whether the Theory of Constraints (TOC can be useful to the logistics of medical records in hospitals. The paper is based on a case study conducted about the 2007-2011 period in the Medical Records Logistics Service at the Hospital Universitario Virgen Macarena in Seville (Spain. From April 2008, a set of actions in the clinical record logistics system were implemented based on the application of TOC principles. The results obtained show a significant increase in the level of service and employee productivity, as well as a reduction of cost and the number of patients’ complaints.

Medical records documentation of constipation preceding Parkinson disease: A case-control study.

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Savica, R; Carlin, J M; Grossardt, B R; Bower, J H; Ahlskog, J E; Maraganore, D M; Bharucha, A E; Rocca, W A

2009-11-24

Parkinson disease (PD) may affect the autonomic nervous system and may cause constipation; however, few studies have explored constipation preceding the motor onset of PD. We investigated constipation preceding PD using a case-control study design in a population-based sample. Using the medical records-linkage system of the Rochester Epidemiology Project, we identified 196 subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (+/-1 year) and sex to a general population control. We reviewed the complete medical records of cases and controls in the medical records-linkage system to ascertain the occurrence of constipation preceding the onset of PD (or index year). Constipation preceding PD or the index year was more common in cases than in controls (odds ratio [OR] 2.48; 95% confidence interval [CI] 1.49 to 4.11; p = 0.0005). This association remained significant after adjusting for smoking and coffee consumption (ever vs never), and after excluding constipation possibly induced by drugs. In addition, the association remained significant in analyses restricted to constipation documented 20 or more years before the onset of motor symptoms of PD. Although the association was stronger in women than in men and in patients with PD with rest tremor compared with patients with PD without rest tremor, these differences were not significant. Our findings suggest that constipation occurring as early as 20 or more years before the onset of motor symptoms is associated with an increased risk of Parkinson disease.

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.

Reorganizing Care With the Implementation of Electronic Medical Records: A Time-Motion Study in the PICU.

Science.gov (United States)

Roumeliotis, Nadia; Parisien, Geneviève; Charette, Sylvie; Arpin, Elizabeth; Brunet, Fabrice; Jouvet, Philippe

2018-04-01

To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records. A prospective, observational, time-motion study. A level 3 PICU. Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008-2009) and after (2016) implementation of reorganization of care in 2013. The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare). Time spent completing various work tasks was recorded by direct observation, and proportion of time in tasks was compared for each study period. A total of 153.7 hours was observed from 22 nurses and 14 orderlies. There was no significant difference in the proportion of nursing patient care time before (68.8% [interquartile range, 48-72%]) and after (55% [interquartile range, 51-57%]) (p = 0.11) the reorganization with electronic medical record. Direct patient care task time for nurses was increased from 27.0% (interquartile range, 30-37%) before to 34.7% (interquartile range, 33-75%) (p = 0.336) after, and indirect patient care tasks decreased from 33.6% (interquartile range, 23-41%) to 18.6% (interquartile range, 16-22%) (p = 0.036). Documentation time significantly increased from 14.5% (interquartile range, 12-22%) to 26.2% (interquartile range, 23-28%) (p = 0.032). Nursing productivity ratio improved from 28.3 to 26.0. A survey revealed that nursing staff was satisfied with the electronic medical record, although there was a concern for the maintenance of oral communication in the unit. The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly

29 CFR 1904.9 - Recording criteria for cases involving medical removal under OSHA standards.

Science.gov (United States)

2010-07-01

... surveillance requirements of an OSHA standard, you must record the case on the OSHA 300 Log. (b) Implementation—(1) How do I classify medical removal cases on the OSHA 300 Log? You must enter each medical removal case on the OSHA 300 Log as either a case involving days away from work or a case involving restricted...

Secure and Trustable Electronic Medical Records Sharing using Blockchain.

Science.gov (United States)

Dubovitskaya, Alevtina; Xu, Zhigang; Ryu, Samuel; Schumacher, Michael; Wang, Fusheng

2017-01-01

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost.

Design of Electronic Medical Record User Interfaces: A Matrix-Based Method for Improving Usability

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Kushtrim Kuqi

2013-01-01

Full Text Available This study examines a new approach of using the Design Structure Matrix (DSM modeling technique to improve the design of Electronic Medical Record (EMR user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians’ time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface.

Perception and adoption of an electronic medication record three years after deployment

DEFF Research Database (Denmark)

Hertzum, Morten; Granlien, Maren Fich

2007-01-01

Region Zealand's electronic medication record is generally perceived by hospital staff as useful but not that easy to use. Neither perceived usefulness nor perceived ease of use is more than weakly correlated with actual adoption. The complex work domain with interdependent staff groups and many...

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

Science.gov (United States)

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

2017-01-01

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

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

OpenAIRE

Winkelman, Warren J.; Leonard, Kevin J.

2004-01-01

There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An ...

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre

DEFF Research Database (Denmark)

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte

2018-01-01

with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. DISCUSSION: We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered......BACKGROUND: Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. METHODS: We...... records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. RESULTS: Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15...

Tradeoffs of Using Administrative Claims and Medical Records to Identify the Use of Personalized Medicine for Patients with Breast Cancer

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Liang, Su-Ying; Phillips, Kathryn A.; Wang, Grace; Keohane, Carol; Armstrong, Joanne; Morris, William M.; Haas, Jennifer S.

2012-01-01

Background Administrative claims and medical records are important data sources to examine healthcare utilization and outcomes. Little is known about identifying personalized medicine technologies in these sources. Objectives To describe agreement, sensitivity, and specificity of administrative claims compared to medical records for two pairs of targeted tests and treatments for breast cancer. Research Design Retrospective analysis of medical records linked to administrative claims from a large health plan. We examined whether agreement varied by factors that facilitate tracking in claims (coding and cost) and that enhance medical record completeness (records from multiple providers). Subjects Women (35 – 65 years) with incident breast cancer diagnosed in 2006–2007 (n=775). Measures Use of human epidermal growth factor receptor 2 (HER2) and gene expression profiling (GEP) testing, trastuzumab and adjuvant chemotherapy in claims and medical records. Results Agreement between claims and records was substantial for GEP, trastuzumab, and chemotherapy, and lowest for HER2 tests. GEP, an expensive test with unique billing codes, had higher agreement (91.6% vs. 75.2%), sensitivity (94.9% vs. 76.7%), and specificity (90.1% vs. 29.2%) than HER2, a test without unique billing codes. Trastuzumab, a treatment with unique billing codes, had slightly higher agreement (95.1% vs. 90%) and sensitivity (98.1% vs. 87.9%) than adjuvant chemotherapy. Conclusions Higher agreement and specificity were associated with services that had unique billing codes and high cost. Administrative claims may be sufficient for examining services with unique billing codes. Medical records provide better data for identifying tests lacking specific codes and for research requiring detailed clinical information. PMID:21422962

Celebrating 40 years of Medical Teacher: As the "last man standing" I look back to help us look forward.

Science.gov (United States)

Jason, Hilliard

2018-04-01

In this reflective, descriptive, analytical, first-person piece, I offer recollections, data, and literature to help elucidate the emergence of medical education as a scholarly field, as part of celebrating Medical Teacher's 40-year anniversary. I emphasize the impressive growth of the professional literature in medical education, and recognize that much remains to be done. Medical education as a domain for research and development has transitioned from being largely ignored during the first 20 of the past 60 years, through a slow growth phase, to rapid acceleration during the last 2 decades. By introducing the use and potential of "edumarkers," we can see that medical education as a focus of scholarly pursuits was absent to minimal before recent decades, and we can identify trends and questions that deserve further exploration. Concern and recommendations: Only a small subset of the large population assigned to instruct health professions learners actually conducts and responds to medical education scholarship. I raise several questions as possible guides to the future for those of us who are devoted to enhancing educational processes and outcomes for learners who are expected to help prevent and manage the health challenges faced by the world's people.

Distribution of Problems, Medications and Lab Results in Electronic Health Records: The Pareto Principle at Work.

Science.gov (United States)

Wright, Adam; Bates, David W

2010-01-01

BACKGROUND: Many natural phenomena demonstrate power-law distributions, where very common items predominate. Problems, medications and lab results represent some of the most important data elements in medicine, but their overall distribution has not been reported. OBJECTIVE: Our objective is to determine whether problems, medications and lab results demonstrate a power law distribution. METHODS: Retrospective review of electronic medical record data for 100,000 randomly selected patients seen at least twice in 2006 and 2007 at the Brigham and Women's Hospital in Boston and its affiliated medical practices. RESULTS: All three data types exhibited a power law distribution. The 12.5% most frequently used problems account for 80% of all patient problems, the top 11.8% of medications account for 80% of all medication orders and the top 4.5% of lab result types account for all lab results. CONCLUSION: These three data elements exhibited power law distributions with a small number of common items representing a substantial proportion of all orders and observations, which has implications for electronic health record design.

Tool Kit Helps Digitize Tide Gauge Records

Science.gov (United States)

Ullmann, Albin; Pons, Frédéric; Moron, Vincent

2005-09-01

The Numérisation des Niveaux d'Eau (NUNIEAU) is an integrated and automated MATLAB computer program tool kit for digitizing, transforming, and validating paper records of sea level variations, called marigrams (Figure 1a), that can cut in half the time required to digitize paper records. This tool kit developed in 2004 by F. Pons is currently obtainable by request from the developer, but will be available online on the IMPLIT (Impact des événements extremes sur les hydro-systèmes du litoral méditerranéen français) Web site in early 2006.

Medical Record Keeping in the Summer Camp Setting.

Science.gov (United States)

Kaufman, Laura; Holland, Jaycelyn; Weinberg, Stuart; Rosenbloom, S Trent

2016-12-14

Approximately one fifth of school-aged children spend a significant portion of their year at residential summer camp, and a growing number have chronic medical conditions. Camp health records are essential for safe, efficient care and for transitions between camp and home providers, yet little research exists regarding these systems. To survey residential summer camps for children to determine how camps create, store, and use camper health records. To raise awareness in the informatics community of the issues experienced by health providers working in a special pediatric care setting. We designed a web-based electronic survey concerning medical recordkeeping and healthcare practices at summer camps. 953 camps accredited by the American Camp Association received the survey. Responses were consolidated and evaluated for trends and conclusions. Of 953 camps contacted, 298 (31%) responded to the survey. Among respondents, 49.3% stated that there was no computer available at the health center, and 14.8% of camps stated that there was not any computer available to health staff at all. 41.1% of camps stated that internet access was not available. The most common complaints concerning recordkeeping practices were time burden, adequate completion, and consistency. Summer camps in the United States make efforts to appropriately document healthcare given to campers, but inconsistency and inefficiency may be barriers to staff productivity, staff satisfaction, and quality of care. Survey responses suggest that the current methods used by camps to document healthcare cause limitations in consistency, efficiency, and communications between providers, camp staff, and parents. As of 2012, survey respondents articulated need for a standard software to document summer camp healthcare practices that accounts for camp-specific needs. Improvement may be achieved if documentation software offers the networking capability, simplicity, pediatrics-specific features, and avoidance of

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

Science.gov (United States)

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

2009-01-01

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

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

Science.gov (United States)

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

2014-03-01

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

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

Science.gov (United States)

Pobocik, Tamara J.

2013-01-01

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

Reflecting on the ethical administration of computerized medical records

Science.gov (United States)

Collmann, Jeff R.

1995-05-01

This presentation examines the ethical issues raised by computerized image management and communication systems (IMAC), the ethical principals that should guide development of policies, procedures and practices for IMACS systems, and who should be involved in developing a hospital's approach to these issues. The ready access of computerized records creates special hazards of which hospitals must beware. Hospitals must maintain confidentiality of patient's records while making records available to authorized users as efficiently as possible. The general conditions of contemporary health care undermine protecting the confidentiality of patient record. Patients may not provide health care institutions with information about themselves under conditions of informed consent. The field of information science must design sophisticated systems of computer security that stratify access, create audit trails on data changes and system use, safeguard patient data from corruption, and protect the databases from outside invasion. Radiology professionals must both work with information science experts in their own hospitals to create institutional safeguards and include the adequacy of security measures as a criterion for evaluating PACS systems. New policies and procedures on maintaining computerized patient records must be developed that obligate all members of the health care staff, not just care givers. Patients must be informed about the existence of computerized medical records, the rules and practices that govern their dissemination and given the opportunity to give or withhold consent for their use. Departmental and hospital policies on confidentiality should be reviewed to determine if revisions are necessary to manage computer-based records. Well developed discussions of the ethical principles and administrative policies on confidentiality and informed consent and of the risks posed by computer-based patient records systems should be included in initial and continuing

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.

Rewriting abortion: deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

Science.gov (United States)

Suh, Siri

2014-01-01

Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in nearly 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion

Application of the STOPP/START criteria to a medical record database.

Science.gov (United States)

Nauta, Katinka J; Groenhof, Feikje; Schuling, Jan; Hugtenburg, Jacqueline G; van Hout, Hein P J; Haaijer-Ruskamp, Flora M; Denig, Petra

2017-10-01

The STOPP/START criteria are increasingly used to assess prescribing quality in elderly patients at practice level. Our aim was to test computerized algorithms for applying these criteria to a medical record database. STOPP/START criteria-based computerized algorithms were defined using Anatomical-Therapeutic-Chemical (ATC) codes for medication and International Classification of Primary Care (ICPC) codes for diagnoses. The algorithms were applied to a Dutch primary care database, including patients aged ≥65 years using ≥5 chronic drugs. We tested for associations with patient characteristics that have previously shown a relationship with the original STOPP/START criteria, using multivariate logistic regression models. Included were 1187 patients with a median age of 75 years. In total, 39 of the 62 STOPP and 18 of the 26 START criteria could be converted to a computerized algorithm. The main reasons for inapplicability were lack of information on the severity of a condition and insufficient covering of ICPC-codes. We confirmed a positive association between the occurrence of both the STOPP and the START criteria and the number of chronic drugs (adjusted OR ranging from 1.37, 95% CI 1.04-1.82 to 3.19, 95% CI 2.33-4.36) as well as the patient's age (adjusted OR for STOPP 1.30, 95% CI 1.01-1.67; for START 1.73, 95% CI 1.35-2.21), and also between female gender and the occurrence of STOPP criteria (adjusted OR 1.41, 95% CI 1.09-1.82). Sixty-five percent of the STOPP/START criteria could be applied with computerized algorithms to a medical record database with ATC-coded medication and ICPC-coded diagnoses. Copyright © 2017 John Wiley & Sons, Ltd.

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

Science.gov (United States)

Driscoll, Molly; Gurka, David

2015-01-01

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

76 FR 53921 - Privacy Act of 1974; Department of Homeland Security ALL-034 Emergency Care Medical Records...

Science.gov (United States)

2011-08-30

... AGENCY: Privacy Office, DHS. ACTION: Notice of Privacy Act system of records. SUMMARY: In accordance with... Security Office of Health Affairs to collect and maintain records on individuals who receive emergency care... consistent, quality medical care. To support MQM, OHA operates the electronic Patient Care Record (ePCR), an...

Continuous 24-hour ocular dimensional profile recording in medically treated normal-tension glaucoma

Directory of Open Access Journals (Sweden)

Lee JWY

2015-01-01

Full Text Available Jacky WY Lee,1,2 Lin Fu,1 Jennifer WH Shum,1 Jonathan CH Chan,3 Jimmy SM Lai1 1Department of Ophthalmology, The University of Hong Kong, Hong Kong; 2Department of Ophthalmology, Caritas Medical Centre, Hong Kong; 3Department of Ophthalmology, Queen Mary Hospital, Hong Kong Purpose: To analyze the 24-hour ocular dimensional profile in normal-tension glaucoma (NTG patients on medical treatment.Methods: Consecutive, medically treated NTG subjects were recruited from a university eye center. Subjects were on a mean of 1.7±0.7 types of antiglaucoma medications and 56.6% were on a prostaglandin analog. A contact lens-based sensor device was worn in one eye of NTG patients to record the intraocular pressure (IOP-related profile for 24 hours, recording the following: variability from mean over 24 hours, nocturnally and diurnally, as well as the number of peaks and troughs diurnally and nocturnally.Results: In 18 NTG subjects, the nocturnal variability around the mean contact lens-based sensor device signal was 48.9% less than the diurnal variability around the mean. The number of peaks was 54.7% less during the nocturnal period than during the diurnal period. The rate of increase in the ocular dimensional profile when going to sleep was significantly greater than the rate of decrease upon waking (P<0.001.Conclusion: In medically treated NTG subjects, there was more variability in the IOP-related pattern during the daytime and there were fewer peaks during sleep. Keywords: intraocular pressure, 24-hour, normal tension glaucoma

Using death certificates and medical examiner records for adolescent occupational fatality surveillance and research: a case study.

Science.gov (United States)

Rauscher, Kimberly J; Runyan, Carol W; Radisch, Deborah

2012-01-01

Death certificates and medical examiner records have been useful yet imperfect data sources for work-related fatality research and surveillance among adult workers. It is unclear whether this holds for work-related fatalities among adolescent workers who suffer unique detection challenges in part because they are not often thought of as workers. This study investigated the utility of using these data sources for surveillance and research pertaining to adolescent work-related fatalities. Using the state of North Carolina as a case study, we analyzed data from the death certificates and medical examiner records of all work-related fatalities data among 11- to 17-year-olds between 1990-2008 (N = 31). We compared data sources on case identification, of completeness, and consistency information. Variables examined included those on the injury (e.g., means), occurrence (e.g., place), demographics, and employment (e.g., occupation). Medical examiner records (90%) were more likely than death certificates (71%) to identify adolescent work-related fatalities. Data completeness was generally high yet varied between sources. The most marked difference being that in medical examiner records, type of business/industry and occupation were complete in 72 and 67% of cases, respectively, while on the death certificates these fields were complete in 90 and 97% of cases, respectively. Taking the two sources together, each field was complete in upward of 94% of cases. Although completeness was high, data were not always of good quality and sometimes conflicted across sources. In many cases, the decedent's occupation was misclassified as "student" and their employer as "school" on the death certificate. Even though each source has its weaknesses, medical examiner records and death certificates, especially when used together, can be useful for conducting surveillance and research on adolescent work-related fatalities. However, extra care is needed by data recorders to ensure that

[Laypersons can seek help from their Facebook friends regarding medical diagnosis].

Science.gov (United States)

Folkestad, Lars; Brodersen, Jacob Broder; Hallas, Peter; Brabrand, Mikkel

2011-12-05

In contrast to Internet search engines, social media on the Internet such as Facebook, Twitter, etc. reach a large number of people, who are ready to help answering questions. This type of information aggregation has been dubbed "crowdsourcing" i.e. outsourcing a task to a large group of people or community (a crowd) through an open call. Our aim was to explore whether laypersons via Facebook friends could crowd source their way to a medical diagnosis based on a brief medical history, posted as a status update on Facebook. The participants posted a brief case story on their Facebook profile and asked their "Facebook friends" to come up with possible diagnoses. The correct diagnosis was suggested in five of the six case stories, and the correct diagnosis was made after a median of ten minutes. The quality of the responses varied from relevant differential diagnoses to very silly diagnostic suggestions. Based on this study, we believe that laypersons can use his or her "Facebook friends" to identify the need to see a doctor for their symptoms rather than relying on them to give them a specific diagnosis for their symptoms.

Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment

DEFF Research Database (Denmark)

Alempijevic, D.; Beriashvili, R.; Beynon, J.

2013-01-01

In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance o...

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

Science.gov (United States)

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

2007-10-11

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

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

Science.gov (United States)

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

2009-12-20

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

Intra-rater and inter-rater reliability of a medical record abstraction study on transition of care after childhood cancer.

Directory of Open Access Journals (Sweden)

Micòl E Gianinazzi

Full Text Available The abstraction of data from medical records is a widespread practice in epidemiological research. However, studies using this means of data collection rarely report reliability. Within the Transition after Childhood Cancer Study (TaCC which is based on a medical record abstraction, we conducted a second independent abstraction of data with the aim to assess a intra-rater reliability of one rater at two time points; b the possible learning effects between these two time points compared to a gold-standard; and c inter-rater reliability.Within the TaCC study we conducted a systematic medical record abstraction in the 9 Swiss clinics with pediatric oncology wards. In a second phase we selected a subsample of medical records in 3 clinics to conduct a second independent abstraction. We then assessed intra-rater reliability at two time points, the learning effect over time (comparing each rater at two time-points with a gold-standard and the inter-rater reliability of a selected number of variables. We calculated percentage agreement and Cohen's kappa.For the assessment of the intra-rater reliability we included 154 records (80 for rater 1; 74 for rater 2. For the inter-rater reliability we could include 70 records. Intra-rater reliability was substantial to excellent (Cohen's kappa 0-6-0.8 with an observed percentage agreement of 75%-95%. In all variables learning effects were observed. Inter-rater reliability was substantial to excellent (Cohen's kappa 0.70-0.83 with high agreement ranging from 86% to 100%.Our study showed that data abstracted from medical records are reliable. Investigating intra-rater and inter-rater reliability can give confidence to draw conclusions from the abstracted data and increase data quality by minimizing systematic errors.

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

Science.gov (United States)

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

2003-01-01

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

Bidirectional RNN for Medical Event Detection in Electronic Health Records.

Science.gov (United States)

Jagannatha, Abhyuday N; Yu, Hong

2016-06-01

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

Medical - and – psychological help to cosmetological patients with disharmonic inflated self-esteem

Directory of Open Access Journals (Sweden)

M. A. Yudin

2017-02-01

Full Text Available Introduction. Classical treatment with medications, procedures, surgery is unable to restore physical health and almost has no effect on the psychological state of a patient. This raises the question of involvement in the treatment process psychological measures, increase knowledge about the psychology of the patient, medical professionals and their interrelation during treatment. The aim: to identify the targets of psychological help for cosmetological patients with disharmonic inflated self-esteem (DISE. Contingent and methods. The study was conducted at the Medical Center "CA Clinic" ( Kyiv during 2014 – 2016. 178 women with cosmetological problems participated in the research, among them 82 had DISE (active treatment group and 93 had harmonic self-esteem (control group. The complex psychodiagnostic study conducted for assessment psychological state. Cosmetological patients emotional condition was studied with SCL-90-R. To study the personality characteristics, Freiburg personality questionnaire (FPI, form B and self-esteem questionnaire by V. V. Stolin and S. G. Pantileyeva were used, behavioral patterns have been investigated with S. Lazarus and Folkman’s method of WCB. Psychosocial sphere was assessed with test for diagnosis of interpersonal relations by T. Leary and social and psychological adaptation by K. Rogers and R. Diamond. Results. DISE patients complete a specific group of patients who seek for cosmetic help. Skin pathology and outwardness changes in this group had negative effects especially in the field of psychosocial functioning. The external view for DISE women is associated with high social status and is a tool of psychological impact on the environment. In DISE women signs of somatization with painful and histrionic displays, tension, nervousness, frustration and distrust for the environment, a sense of loneliness were present in the psycho-emotional sphere. For DISE patients  personality and behavioral patterns such

Paperless chart recording helps cut costs

International Nuclear Information System (INIS)

Collier, K.; Sullivan, M.E.

1997-01-01

Turbine generator data acquisition systems using personal computers have been installed at the Limerick BWR power plant to replace paper-based chart recorders. This plant is already one of the lowest cost nuclear power plants in the US and this innovation will boost operating efficiency still further. The Limerick control room now has wall-mounted touch screen video displays which provide operators with real-time, electronically achieved information and improving information flow, with a consolidated, consistent user interface. (UK)

The present state of the medical record data base for the A-bomb survivors in Nagasaki University

International Nuclear Information System (INIS)

Mori, Hiroyuki; Mine, Mariko; Kondo, Hisayoshi; Okumura, Yutaka

1992-01-01

It has been 13 years since the operation of medical record data base for A-bomb survivors was started in the Scientific Data Center for Atomic Bomb Disaster at the Nagasaki University. This paper presents the basic data in handling the data base. The present data base consists of the following 6 items: (1) 'fundamental data' for approximately 120,000 A-bomb survivors having an A-bomb survivors' handbook who have been living in Nagasaki City; (2) 'Nagasaki Atomic Bomb Hospital's data', covering admission medical records in the ward of internal medicine; (3) 'pathological data', covering autopsy records in Nagasaki City; (4) 'household data reconstructed by the survey data'; (5) 'second generation A-bomb survivors data', including the results of mass screening since 1979, and (6) 'address data'. Based on the data, the number of A-bomb survivors, diagnosis records at the time of death, the number of A-bomb survivors' participants in health examination, tumor registration, records of admission to the internal ward in Nagasaki Atomic Bomb Hospital, autopsy records, and household records are tabulated in relation to annual changes, age at the time of A-bombing, distance from the hypocenter, or sex. (N.K.)

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

Science.gov (United States)

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

1996-01-01

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

Automating payroll, billing, and medical records. Using technology to do more with less.

Science.gov (United States)

Vetter, E

1995-08-01

As home care agencies grow, so does the need to streamline the paperwork involved in running an agency. One agency found a way to reduce its payroll, billing, and medical records paperwork by implementing an automated, image-based data collection system that saves time, money, and paper.

Students helping students: vertical peer mentoring to enhance the medical school experience.

Science.gov (United States)

Andre, Christine; Deerin, Jessica; Leykum, Luci

2017-05-02

Effective mentoring is an important component of medical student professional development. We provide a description of the mentoring program at our institution. Our institution UTHSCSA implemented a student-advising program (Veritas) with clinical faculty mentors and senior students (MiMs). The MiMs provided vertical peer mentoring to more junior students as an adjunct to faculty advising. The MiMs lead small group discussions that foster camaraderie, share academic and career information and promote professional identity. An optional MiM elective more intensively develops mentorship and leadership skills through a formal curriculum. The authors used annual survey data of all students as well as student mentors to evaluate program effectiveness. Overall, student perception of the program improved each year across multiple domains, including feeling more prepared, supported and satisfied with their overall experience in medical school. Student mentors also found the process rewarding and helpful to their future careers as physicians. The authors suggest implementing a vertical peer-mentoring program can be an effective adjunct to faculty mentoring.

Enhancing the power of genetic association studies through the use of silver standard cases derived from electronic medical records.

Directory of Open Access Journals (Sweden)

Andrew McDavid

Full Text Available The feasibility of using imperfectly phenotyped "silver standard" samples identified from electronic medical record diagnoses is considered in genetic association studies when these samples might be combined with an existing set of samples phenotyped with a gold standard technique. An analytic expression is derived for the power of a chi-square test of independence using either research-quality case/control samples alone, or augmented with silver standard data. The subset of the parameter space where inclusion of silver standard samples increases statistical power is identified. A case study of dementia subjects identified from electronic medical records from the Electronic Medical Records and Genomics (eMERGE network, combined with subjects from two studies specifically targeting dementia, verifies these results.

Object-orientated DBMS techniques for time-oriented medical record.

Science.gov (United States)

Pinciroli, F; Combi, C; Pozzi, G

1992-01-01

In implementing time-orientated medical record (TOMR) management systems, use of a relational model played a big role. Many applications have been developed to extend query and data manipulation languages to temporal aspects of information. Our experience in developing TOMR revealed some deficiencies inside the relational model, such as: (a) abstract data type definition; (b) unified view of data, at a programming level; (c) management of temporal data; (d) management of signals and images. We identified some first topics to face by an object-orientated approach to database design. This paper describes the first steps in designing and implementing a TOMR by an object-orientated DBMS.

WE-H-201-01: The Opportunities and Benefits of Helping LMICs: How Helping Them Can Help You

International Nuclear Information System (INIS)

Pollard, J.

2016-01-01

The desperate need for radiotherapy in low and mid-income countries (LMICs) has been well documented. Roughly 60 % of the worldwide incidence of cancer occurs in these resource-limited settings and the international community alongside governmental and non-profit agencies have begun publishing reports and seeking help from qualified volunteers. However, the focus of several reports has been on how dire the situation is and the magnitude of the problem, leaving most to feel overwhelmed and unsure as to how to help and why to get involved. This session will help to explain the specific ways that Medical Physicists can uniquely assist in this grand effort to help bring radiotherapy to grossly-underserved areas. Not only can these experts fulfill an important purpose, they also can benefit professionally, academically, emotionally and socially from the endeavor. By assisting others worldwide with their skillset, Medical Physicists can end up helping themselves. Learning Objectives: Understand the need for radiotherapy in LMICs. Understand which agencies are seeking Medical Physicists for help in LMICs. Understand the potential research funding mechanisms are available to establish academic collaborations with LMIC researchers/physicians. Understand the potential social and emotional benefits for both the physicist and the LMIC partners when collaborations are made. Understand the potential for collaboration with other high-income scientists that can develop as the physicist partners with other large institutions to assist LMICs. Wil Ngwa - A recent United Nations Study reports that in developing countries more people have access to cell phones than toilets. In Africa, only 63% of the population has access to piped water, yet, 93% of Africans have cell phone service. Today, these cell phones, Skype, WhatsApp and other information and communication technologies (ICTs) connect us in unprecedented ways and are increasingly recognized as powerful, indispensable to global

WE-H-201-01: The Opportunities and Benefits of Helping LMICs: How Helping Them Can Help You

Energy Technology Data Exchange (ETDEWEB)

Pollard, J. [MD Anderson Cancer Center (United States)

2016-06-15

The desperate need for radiotherapy in low and mid-income countries (LMICs) has been well documented. Roughly 60 % of the worldwide incidence of cancer occurs in these resource-limited settings and the international community alongside governmental and non-profit agencies have begun publishing reports and seeking help from qualified volunteers. However, the focus of several reports has been on how dire the situation is and the magnitude of the problem, leaving most to feel overwhelmed and unsure as to how to help and why to get involved. This session will help to explain the specific ways that Medical Physicists can uniquely assist in this grand effort to help bring radiotherapy to grossly-underserved areas. Not only can these experts fulfill an important purpose, they also can benefit professionally, academically, emotionally and socially from the endeavor. By assisting others worldwide with their skillset, Medical Physicists can end up helping themselves. Learning Objectives: Understand the need for radiotherapy in LMICs. Understand which agencies are seeking Medical Physicists for help in LMICs. Understand the potential research funding mechanisms are available to establish academic collaborations with LMIC researchers/physicians. Understand the potential social and emotional benefits for both the physicist and the LMIC partners when collaborations are made. Understand the potential for collaboration with other high-income scientists that can develop as the physicist partners with other large institutions to assist LMICs. Wil Ngwa - A recent United Nations Study reports that in developing countries more people have access to cell phones than toilets. In Africa, only 63% of the population has access to piped water, yet, 93% of Africans have cell phone service. Today, these cell phones, Skype, WhatsApp and other information and communication technologies (ICTs) connect us in unprecedented ways and are increasingly recognized as powerful, indispensable to global

Medical Individualism or Medical Familism? A Critical Analysis of China's New Guidelines for Informed Consent: The Basic Norms of the Documentation of the Medical Record.

Science.gov (United States)

Bian, Lin

2015-08-01

Modern Western medical individualism has had a significant impact on health care in China. This essay demonstrates the ways in which such Western-style individualism has been explicitly endorsed in China's 2010 directive: The Basic Norms of the Documentation of the Medical Record. The Norms require that the patient himself, rather than a member of his family, sign each informed consent form. This change in clinical practice indicates a shift toward medical individualism in Chinese healthcare legislation. Such individualism, however, is incompatible with the character of Chinese familism that is deeply rooted in the Chinese ethical tradition. It also contradicts family-based patterns of health care in China. Moreover, the requirement for individual informed consent is incompatible with numerous medical regulations promulgated in the past two decades. This essay argues that while Chinese medical legislation should learn from relevant Western ideas, it should not simply copy such practices by importing medical individualism into Chinese health care. Chinese healthcare policy is properly based on Chinese medical familist resources. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Insomnia patients' help-seeking experiences.

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Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Glozier, Nicholas; Saini, Bandana

2014-03-04

Timely access to appropriate treatment is important for optimizing insomnia management. To date, little is known about insomnia patients' treatment experiences or how they access and engage with the available health care resources. This study sought to capture the help-seeking experiences and behavioral patterns of patients with insomnia who are seeking or receiving specialist care. A purposive sample of 26 insomnia patients from specialist sleep and mental health clinics located in metropolitan New South Wales, Australia was recruited. Participants completed a brief questionnaire, followed by an in-depth, semi-structured interview. Interviews were digitally recorded, transcribed verbatim, and analyzed using framework analysis. Three key themes emerged from the data: patients' sleep beliefs, treatment beliefs, and accessing specialized care. The findings show that daytime symptoms arising from insomnia serve as important illness cues for patients to seek medical help. In addition, participants' treatment pathways highlight factors that prevent the widespread use of cognitive behavioral therapy for insomnia (CBT-I), including limited awareness about CBT-I, tentative referral mechanisms, limited service providers, and the high cost of CBT-I.

Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs.

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St-Maurice, Justin D; Burns, Catherine M

2017-07-28

Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient's domain and enable the exploration of the shared decision-making (SDM) paradigm. Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a

The influence of risk labeling on risk perception and willingness to seek help in an experimental simulation of preventive medical examinations.

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Nieuwenhuijsen, Karen; Hulshof, Carel T; Sluiter, Judith K

2018-07-01

To study the influence of the presentation of results of a preventive medical examination on risk perception and willingness to seek help for work-related fatigue or being overweight. A factorial design experiment was conducted, presenting workers (n = 82) with vignettes including eight scenarios of test results with and without an emphasis on the risk of a current or future health condition or a probe to seek help. Participants rated perceived risk and willingness to seek help (0-100 Visual Analogue Scale) as if these were their own results. Differences were tested with paired-sample t-tests. In scenarios emphasizing the risk of a current or future disorder, participants perceived higher risk and were more willing to seek help (p-values < .00). Slightly higher willingness to seek help scores was observed in all scenarios that included probes (p < .00). Risk perception and willingness to seek help of workers participating in a preventive medical examination were higher when they were told that the test results indicate a risk of a current or future disorder and after being advised to seek help. Healthcare providers should take the potential effects on risk perception and help-seeking into account in preventive settings. Copyright © 2018. Published by Elsevier B.V.

Public Interest in Medical Research Participation: Does It Matter if Patients or Community Members Have Helped Design the Study?

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Cobb, Enesha M; Gebremariam, Achamyeleh; Singer, Dianne; Davis, Matthew M

2015-10-01

We determined national levels of public participation in medical research study design. We compared public interest in medical research participation (MRP) in studies overall, versus studies explicitly designed with public involvement. Cross-sectional household survey of US population in June 2013. Descriptive statistics estimated participation in medical research study design. Chi-square test compared levels of interest in MRP if respondent knew patients or community members helped design the study. Of 2,048 respondents (participation rate 60%), 5% knew someone who had helped design a medical research study. There was no association between having known someone or personal participation in study design and willingness to engage in MRP. Although the overall proportion of respondents who would consider MRP initially (51%) was similar to the proportion who would consider MRP with community member involvement in study design (49%), the changes in respondents' views across the different scenarios were significantly greater than what would have been expected by chance. We found similar levels of interest in MRP whether or not the public is involved in medical research study design. This finding may indicate that public involvement in study design, like community-based participatory research, may not affect overall rates of MRP. © 2015 Wiley Periodicals, Inc.

Implementing electronic medical record systems in developing countries

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Hamish Fraser

2005-06-01

Full Text Available The developing world faces a series of health crises including HIV/AIDS and tuberculosis that threaten the lives of millions of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. In this paper we explain why information systems are important in many healthcare projects in the developing world. We discuss pilot projects demonstrating that such systems are possible and can expand to manage hundreds of thousands of patients. We also pass on the most important practical lessons in design and implementation from our experience in doing this work. Finally, we discuss the importance of collaboration between projects in the development of electronic medical record systems rather than reinventing systems in isolation, and the use of open standards and open source software.

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

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

2016-01-01

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

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

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Steven C Bagley

2016-04-01

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

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

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

2012-06-01

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

OSHA Final Rule Gives Employees the Right to See Their Exposure and Medical Records.

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Hayes, Mary

1982-01-01

Provides details pertaining to the Occupational Safety and Health Administration (OSHA) ruling that gives employees, their designated representatives, and OSHA the right to examine their on-the-job medical records. Discusses the effects the ruling may have on organizations. (Author/MLF)

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

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Rebecca Levy

2010-01-01

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

Effect of educational and electronic medical record interventions on food allergy management.

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Zelig, Ari; Harwayne-Gidansky, Ilana; Gault, Allison; Wang, Julie

2016-09-01

The growing prevalence of food allergies indicates a responsibility among primary care providers to ensure that their patients receive accurate diagnosis and management. To improve physician knowledge and management of food allergies by implementing educational and electronic medical record interventions. Pre- and posttest scores of pediatric residents and faculty were analyzed to assess the effectiveness of an educational session designed to improve knowledge of food allergy management. One year later, a best practice advisory was implemented in the electronic medical record to alert providers to consider allergy referral whenever a diagnosis code for food allergy or epinephrine autoinjector prescription was entered. A review of charts 6 months before and 6 months after each intervention was completed to determine the impact of both interventions. Outcome measurements included referrals to an allergy clinic, prescription of self-injectable epinephrine, and documentation that written emergency action plans were provided. There was a significant increase in test scores immediately after the educational intervention (mean, 56.2 versus 84.3%; p management of children with food allergies at our pediatrics clinic. Further studies are needed to identify effective strategies to improve management of food allergies by primary care physicians.

[Study on medical records of acupuncture-moxibustion in The Twenty-four Histories].

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Huang, Kai-Wen

2012-03-01

Through the combination of manual retrieval and computerized retrieval, medical records of acupuncture-moxibustion in The Twenty-Four Histories were collected. Acupuncture cases from the Spring and Autumn Period (770-476 B.C.) to the end of the Ming Dynasty (1368-1644)were retrieved. From the medical records of acupuncture-moxibustion in Chinese official history books, it can be found that systematic diseases or emergent and severe diseases were already treated by physicians with the combination of acupuncture and medicine as early as in the Spring and Autumn Period as well as the Warring States Period(475-221 B.C.). CANG Gong, a famous physician of the Western Han Dynasty (206 B. C.-A. D. 24), cured diseases by selecting points along the running courses of meridians where the illness inhabited, which indicates that the theory of meridians and collaterals was served as a guide for clinical practice as early as in the Western Han Dynasty. Blood letting therapy, which has surprising effect, was often adopted by physicians of various historical periods to treat diseases. And treatment of diseases with single point was approved to be easy and effective.

How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach.

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Duke, Pamela; Frankel, Richard M; Reis, Shmuel

2013-01-01

Implementation of the electronic health record (EHR) has changed the dynamics of doctor-patient communication. Physicians train to use EHRs from a technical standpoint, giving only minimal attention to integrating the human dimensions of the doctor-patient relationship into the computer-accompanied medical visit. This article reviews the literature and proposes a model to help clinicians, residents, and students improve physician-patient communication while using the EHR. We conducted a literature search on use of communication skills when interfacing with the EHR. We observed an instructional gap and developed a model using evidence-based communication skills. This model integrates patient-centered interview skills and aims to empower physicians to remain patient centered while effectively using EHRs. It may also serve as a template for future educational and practice interventions for use of the EHR in the examination room.

Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record.

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Wright, Adam; Sittig, Dean F; McGowan, Julie; Ash, Joan S; Weed, Lawrence L

2014-01-01

Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software--over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

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

2006-06-01

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

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

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Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

Understanding key factors affecting electronic medical record implementation: a sociotechnical approach.

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Cucciniello, Maria; Lapsley, Irvine; Nasi, Greta; Pagliari, Claudia

2015-07-17

Recent health care policies have supported the adoption of Information and Communication Technologies (ICT) but examples of failed ICT projects in this sector have highlighted the need for a greater understanding of the processes used to implement such innovations in complex organizations. This study examined the interaction of sociological and technological factors in the implementation of an Electronic Medical Record (EMR) system by a major national hospital. It aimed to obtain insights for managers planning such projects in the future and to examine the usefulness of Actor Network Theory (ANT) as a research tool in this context. Case study using documentary analysis, interviews and observations. Qualitative thematic analysis drawing on ANT. Qualitative analyses revealed a complex network of interactions between organizational stakeholders and technology that helped to shape the system and influence its acceptance and adoption. The EMR clearly emerged as a central 'actor' within this network. The results illustrate how important it is to plan innovative and complex information systems with reference to (i) the expressed needs and involvement of different actors, starting from the initial introductory phase; (ii) promoting commitment to the system and adopting a participative approach; (iii) defining and resourcing new roles within the organization capable of supporting and sustaining the change and (iv) assessing system impacts in order to mobilize the network around a common goal. The paper highlights the organizational, cultural, technological, and financial considerations that should be taken into account when planning strategies for the implementation of EMR systems in hospital settings. It also demonstrates how ANT may be usefully deployed in evaluating such projects.

Development of a clinical information tool for the electronic medical record: a case study.

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Epstein, Barbara A; Tannery, Nancy H; Wessel, Charles B; Yarger, Frances; LaDue, John; Fiorillo, Anthony B

2010-07-01

What is the process of developing a clinical information tool to be embedded in the electronic health record of a very large and diverse academic medical center? The development took place at the University of Pittsburgh Health Sciences Library System. The clinical information tool developed is a search box with subject tabs to provide quick access to designated full-text information resources. Each subject tab offers a federated search of a different pool of resources. Search results are organized "on the fly" into meaningful categories using clustering technology and are directly accessible from the results page. After more than a year of discussion and planning, a clinical information tool was embedded in the academic medical center's electronic health record. The library successfully developed a clinical information tool, called Clinical-e, for use at the point of care. Future development will refine the tool and evaluate its impact and effectiveness.

Cognitive complexity of the medical record is a risk factor for major adverse events.

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Roberson, David; Connell, Michael; Dillis, Shay; Gauvreau, Kimberlee; Gore, Rebecca; Heagerty, Elaina; Jenkins, Kathy; Ma, Lin; Maurer, Amy; Stephenson, Jessica; Schwartz, Margot

2014-01-01

Patients in tertiary care hospitals are more complex than in the past, but the implications of this are poorly understood as "patient complexity" has been difficult to quantify. We developed a tool, the Complexity Ruler, to quantify the amount of data (as bits) in the patient’s medical record. We designated the amount of data in the medical record as the cognitive complexity of the medical record (CCMR). We hypothesized that CCMR is a useful surrogate for true patient complexity and that higher CCMR correlates with risk of major adverse events. The Complexity Ruler was validated by comparing the measured CCMR with physician rankings of patient complexity on specific inpatient services. It was tested in a case-control model of all patients with major adverse events at a tertiary care pediatric hospital from 2005 to 2006. The main outcome measure was an externally reported major adverse event. We measured CCMR for 24 hours before the event, and we estimated lifetime CCMR. Above empirically derived cutoffs, 24-hour and lifetime CCMR were risk factors for major adverse events (odds ratios, 5.3 and 6.5, respectively). In a multivariate analysis, CCMR alone was essentially as predictive of risk as a model that started with 30-plus clinical factors. CCMR correlates with physician assessment of complexity and risk of adverse events. We hypothesize that increased CCMR increases the risk of physician cognitive overload. An automated version of the Complexity Ruler could allow identification of at-risk patients in real time.

Evaluation of medical record quality and communication skills among pediatric interns after standardized parent training history-taking in China.

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Yu, Mu Xue; Jiang, Xiao Yun; Li, Yi Juan; Shen, Zhen Yu; Zhuang, Si Qi; Gu, Yu Fen

2018-02-01

The effect of using standardized parent training history-taking on the quality of medical records and communication skills among pediatric interns was determined. Fifth-year interns who were undertaking a pediatric clinical practice rotation were randomized to intervention and control groups. All of the pediatric interns received history-taking training by lecture and bedside teaching. The pediatric interns in the intervention group also received standardized parent history-taking training. The following two outcome measures were used: the scores of medical records, which were written by the pediatric interns after history-taking from real parents of pediatric patients; and the communication assessment tool (CAT) assessed by real parents. The general information, history of present illness (HPI), past medical history, personal history, family history, diagnosis, diagnostic analysis, and differential diagnosis scores in the intervention group were significantly higher than the control group (p history-taking is effective in improving the quality of medical records by pediatric interns. Standardized parent training history-taking is a superior teaching tool for clinical reasoning ability, as well as communication skills in clinical pediatric practice.

Registries Help Moms Measure Medication Risks

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... in the case of the North American Antiepileptic Drug Pregnancy Registry, which studies the effects of drugs for ... is taking. For example, the North American Antiepileptic Drug Pregnancy Registry website lists more than 30 medications being ...

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

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Aldukheil, Maher A.

2013-01-01

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

Health Care Professionals’ Pain Narratives in Hospitalized Children’s Medical Records. Part 1: Pain Descriptors

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Judy Rashotte

2013-01-01

Full Text Available BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children.

Evaluation of Electronic Medical Record (EMR at large urban primary care sexual health centre.

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Christopher K Fairley

Full Text Available OBJECTIVE: Despite substantial investment in Electronic Medical Record (EMR systems there has been little research to evaluate them. Our aim was to evaluate changes in efficiency and quality of services after the introduction of a purpose built EMR system, and to assess its acceptability by the doctors, nurses and patients using it. METHODS: We compared a nine month period before and after the introduction of an EMR system in a large sexual health service, audited a sample of records in both periods and undertook anonymous surveys of both staff and patients. RESULTS: There were 9,752 doctor consultations (in 5,512 consulting hours in the Paper Medical Record (PMR period and 9,145 doctor consultations (in 5,176 consulting hours in the EMR period eligible for inclusion in the analysis. There were 5% more consultations per hour seen by doctors in the EMR period compared to the PMR period (rate ratio = 1.05; 95% confidence interval, 1.02, 1.08 after adjusting for type of consultation. The qualitative evaluation of 300 records for each period showed no difference in quality (P>0.17. A survey of clinicians demonstrated that doctors and nurses preferred the EMR system (P<0.01 and a patient survey in each period showed no difference in satisfaction of their care (97% for PMR, 95% for EMR, P = 0.61. CONCLUSION: The introduction of an integrated EMR improved efficiency while maintaining the quality of the patient record. The EMR was popular with staff and was not associated with a decline in patient satisfaction in the clinical care provided.

Usability Evaluation of An Electronic Medication Administration Record (eMAR) Application

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Guo, J.; Iribarren, S.; Kapsandoy, S.; Perri, S.; Staggers, N.

2011-01-01

Background Electronic medication administration records (eMARs) have been widely used in recent years. However, formal usability evaluations are not yet available for these vendor applications, especially from the perspective of nurses, the largest group of eMAR users. Objective To conduct a formal usability evaluation of an implemented eMAR. Methods Four evaluators examined a commercial vendor eMAR using heuristic evaluation techniques. The evaluators defined seven tasks typical of eMAR use and independently evaluated the application. Consensus techniques were used to obtain 100% agreement of identified usability problems and severity ratings. Findings were reviewed with 5 clinical staff nurses and the Director of Clinical Informatics who verified findings with a small group of clinical nurses. Results Evaluators found 60 usability problems categorized into 233 heuristic violations. Match, Error, and Visibility heuristics were the most frequently violated. Administer Medication and Order and Modify Medications tasks had the highest number of heuristic violations and usability problems rated as major or catastrophic. Conclusion The high number of usability problems could impact the effectiveness, efficiency and satisfaction of nurses’ medication administration activities and may include concerns about patient safety. Usability is a joint responsibility between sites and vendors. We offer a call to action for usability evaluations at all sites and eMAR application redesign as necessary to improve the user experience and promote patient safety. PMID:23616871

Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning

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Angelos P. Kassianos

2017-10-01

Full Text Available Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth applications (“apps” to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions.Method: Three platform descriptions (Apple, Google, and Microsoft were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis.Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor.Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to

Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning.

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Kassianos, Angelos P; Georgiou, Giorgos; Papaconstantinou, Electra P; Detzortzi, Angeliki; Horne, Rob

2017-01-01

Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications ("apps") to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions. Method: Three platform descriptions (Apple, Google, and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis. Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor. Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non

Play as a mechanism of working through medical trauma for children with medical illnesses and their siblings.

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Nabors, Laura; Bartz, Jennifer; Kichler, Jessica; Sievers, Rebecca; Elkins, Rebecca; Pangallo, Jordan

2013-09-01

Children's reactions to medical trauma have been recorded through play. In this study, participants were 15 children with medical illnesses, 14 siblings of children with a medical illness, and 6 children in the community who did not have any ill family members. Children participated in play groups and their play with medical toys was videotaped and coded for themes that would provide a window on their perspectives. The play of children with medical illnesses and siblings was similar. Medical play was a mechanism for imaginal coping and working through stress related to medical experiences. In contrast, children in the comparison group did not engage in much medical play and when they did, they did not demonstrate a rich play experience with detailed medical stories. Future research should focus on ways to use play therapy techniques to help medically ill children and their siblings cope with their feelings and reactions to medical events related to chronic illness.

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

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

2014-09-01

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

Principle and engineering implementation of 3D visual representation and indexing of medical diagnostic records (Conference Presentation)

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Shi, Liehang; Sun, Jianyong; Yang, Yuanyuan; Ling, Tonghui; Wang, Mingqing; Zhang, Jianguo

2017-03-01

Purpose: Due to the generation of a large number of electronic imaging diagnostic records (IDR) year after year in a digital hospital, The IDR has become the main component of medical big data which brings huge values to healthcare services, professionals and administration. But a large volume of IDR presented in a hospital also brings new challenges to healthcare professionals and services as there may be too many IDRs for each patient so that it is difficult for a doctor to review all IDR of each patient in a limited appointed time slot. In this presentation, we presented an innovation method which uses an anatomical 3D structure object visually to represent and index historical medical status of each patient, which is called Visual Patient (VP) in this presentation, based on long term archived electronic IDR in a hospital, so that a doctor can quickly learn the historical medical status of the patient, quickly point and retrieve the IDR he or she interested in a limited appointed time slot. Method: The engineering implementation of VP was to build 3D Visual Representation and Index system called VP system (VPS) including components of natural language processing (NLP) for Chinese, Visual Index Creator (VIC), and 3D Visual Rendering Engine.There were three steps in this implementation: (1) an XML-based electronic anatomic structure of human body for each patient was created and used visually to index the all of abstract information of each IDR for each patient; (2)a number of specific designed IDR parsing processors were developed and used to extract various kinds of abstract information of IDRs retrieved from hospital information systems; (3) a 3D anatomic rendering object was introduced visually to represent and display the content of VIO for each patient. Results: The VPS was implemented in a simulated clinical environment including PACS/RIS to show VP instance to doctors. We setup two evaluation scenario in a hospital radiology department to evaluate whether

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

Directory of Open Access Journals (Sweden)

Hongyi Mao

2017-01-01

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

Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting.

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Wald, Hedy S; George, Paul; Reis, Shmuel P; Taylor, Julie Scott

2014-03-01

While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills.

Video-recorded simulated patient interactions: can they help develop clinical and communication skills in today's learning environment?

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Seif, Gretchen A; Brown, Debora

2013-01-01

It is difficult to provide real-world learning experiences for students to master clinical and communication skills. The purpose of this paper is to describe a novel instructional method using self- and peer-assessment, reflection, and technology to help students develop effective interpersonal and clinical skills. The teaching method is described by the constructivist learning theory and incorporates the use of educational technology. The learning activities were incorporated into the pre-clinical didactic curriculum. The students participated in two video-recording assignments and performed self-assessments on each and had a peer-assessment on the second video-recording. The learning activity was evaluated through the self- and peer-assessments and an instructor-designed survey. This evaluation identified several themes related to the assignment, student performance, clinical behaviors and establishing rapport. Overall the students perceived that the learning activities assisted in the development of clinical and communication skills prior to direct patient care. The use of video recordings of a simulated history and examination is a unique learning activity for preclinical PT students in the development of clinical and communication skills.

Evaluating the utility of provider-recorded clinical status in the medical records of HIV-positive adults in a limited-resource setting

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Stonbraker, Samantha; Befus, Montina; Nadal, Leonel Lerebours; Halpern, Mina; Larson, Elaine

2016-01-01

Provider-reported summaries of clinical status may assist with clinical management of HIV in resource poor settings if they reflect underlying biological processes associated with HIV disease progression. However, their ability to do so is rarely evaluated. Therefore, we aimed to assess the relationship between a provider-recorded summary of clinical status and indicators of HIV progression. Data were abstracted from 201 randomly selected medical records at a large HIV clinic in the Dominican Republic. Multivariable logistic regressions were used to examine the relationship between provider-assigned clinical status and demographic (gender, age, nationality, education) and clinical factors (reported medication adherence, CD4 cell count, viral load). The mean age of patients was 41.2 (SD = ±10.9) years and most were female (n = 115, 57%). None of the examined characteristics were significantly associated with provider-recorded clinical status. Higher CD4 cell counts were more likely for females (OR = 2.2 CI: 1.12–4.31) and less likely for those with higher viral loads (OR = 0.33 CI: 0.15–0.72). Poorer adherence and lower CD4 cell counts were significantly associated with higher viral loads (OR = 4.46 CI: 1.11–20.29 and 6.84 CI: 1.47–37.23, respectively). Clinics using provider-reported summaries of clinical status should evaluate the performance of these assessments to ensure they are associated with biologic indicators of disease progression. PMID:27495146

Electronic medical records and efficiency and productivity during office visits.

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Furukawa, Michael F

2011-04-01

To estimate the relationship between electronic medical record (EMR) use and efficiency of utilization and provider productivity during visits to US office-based physicians. Cross-sectional analysis of the 2006-2007 National Ambulatory Medical Care Survey. The sample included 62,710 patient visits to 2625 physicians. EMR systems included demographics, clinical notes, prescription orders, and laboratory and imaging results. Efficiency was measured as utilization of examinations, laboratory tests, radiology procedures, health education, nonmedication treatments, and medications. Productivity was measured as total services provided per 20-minute period. Survey-weighted regressions estimated association of EMR use with services provided, visit intensity/duration, and productivity. Marginal effects were estimated by averaging across all visits and by major reason for visit. EMR use was associated with higher probability of any examination (7.7%, 95% confidence interval [CI] = 2.4%, 13.1%); any laboratory test (5.7%, 95% CI = 2.6%, 8.8%); any health education (4.9%, 95% CI = 0.2%, 9.6%); and fewer laboratory tests (-7.1%, 95% CI = -14.2%, -0.1%). During pre/post surgery visits, EMR use was associated with 7.3% (95% CI= -12.9%, -1.8%) fewer radiology procedures. EMR use was not associated with utilization of nonmedication treatments and medications, or visit duration. During routine visits for a chronic problem, EMR use was associated with 11.2% (95% CI = 5.7%, 16.8%) more diagnostic/screening services provided per 20-minute period. EMR use had a mixed association with efficiency and productivity during office visits. EMRs may improve provider productivity, especially during visits for a new problem and routine chronic care.

Identification of a potential fibromyalgia diagnosis using random forest modeling applied to electronic medical records

OpenAIRE

Masters, Elizabeth T.; Emir,Birol; Mardekian,Jack; Clair,Andrew; Kuhn,Max; Silverman,Stuart

2015-01-01

Birol Emir,1 Elizabeth T Masters,1 Jack Mardekian,1 Andrew Clair,1 Max Kuhn,2 Stuart L Silverman,3 1Pfizer Inc., New York, NY, 2Pfizer Inc., Groton, CT, 3Cedars-Sinai Medical Center, Los Angeles, CA, USA Background: Diagnosis of fibromyalgia (FM), a chronic musculoskeletal condition characterized by widespread pain and a constellation of symptoms, remains challenging and is often delayed. Methods: Random forest modeling of electronic medical records was used to identify variables that may fa...

Management evaluation about introduction of electric medical record in the national hospital organization.

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Nakagawa, Yoshiaki; Tomita, Naoko; Irisa, Kaoru; Yoshihara, Hiroyuki; Nakagawa, Yoshinobu

2013-01-01

Introduction of Electronic Medical Record (EMR) into a hospital was started from 1999 in Japan. Then, most of all EMR company said that EMR improved efficacy of the management of the hospital. National Hospital Organization (NHO) has been promoting the project and introduced EMR since 2004. NHO has 143 hospitals, 51 hospitals offer acute-phase medical care services, the other 92 hospitals offer medical services mainly for chronic patients. We conducted three kinds of investigations, questionnaire survey, checking the homepage information of the hospitals and analyzing the financial statements of each NHO hospital. In this financial analysis, we applied new indicators which have been developed based on personnel costs. In 2011, there are 44 hospitals which have introduced EMR. In our result, the hospital with EMR performed more investment of equipment/capital than personnel expenses. So, there is no advantage of EMR on the financial efficacy.

Market factors and electronic medical record adoption in medical practices.

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Menachemi, Nir; Mazurenko, Olena; Kazley, Abby Swanson; Diana, Mark L; Ford, Eric W

2012-01-01

Previous studies identified individual or practice factors that influence practice-based physicians' electronic medical record (EMR) adoption. Less is known about the market factors that influence physicians' EMR adoption. The aim of this study was to explore the relationship between environmental market characteristics and physicians' EMR adoption. The Health Tracking Physician Survey 2008 and Area Resource File (2008) were combined and analyzed. Binary logistic regression was used to examine the relationship between three dimensions of the market environment (munificence, dynamism, and complexity) and EMR adoption controlling for several physician and practice characteristics. In a nationally representative sample of 4,720 physicians, measures of market dynamism including increases in unemployment, odds ratio (OR) = 0.95, 95% confidence interval (CI) [0.91, 0.99], or poverty rates, OR = 0.93, 95% CI [0.89, 0.96], were negatively associated with EMR adoption. Health maintenance organization penetration, OR = 3.01, 95% CI [1.49, 6.05], another measure of dynamism, was positively associated with EMR adoption. Physicians practicing in areas with a malpractice crisis, OR = 0.82, 95% CI [0.71, 0.94], representing environmental complexity, had lower EMR adoption rates. Understanding how market factors relate to practice-based physicians' EMR adoption can assist policymakers to better target limited resources as they work to realize the national goal of universal EMR adoption and meaningful use.

Estimating morbidity rates from electronic medical records in general practice: evaluation of a grouping system.

NARCIS (Netherlands)

Biermans, M.C.J.; Verheij, R.A.; Bakker, D.H. de; Zielhuis, G.A.; Vries Robbé, P.F. de

2008-01-01

Objectives: In this study, we evaluated the internal validity of EPICON, an application for grouping ICPCcoded diagnoses from electronic medical records into episodes of care. These episodes are used to estimate morbidity rates in general practice. Methods: Morbidity rates based on EPICON were

Medical tourism in Thailand: a cross-sectional study.

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Noree, Thinakorn; Hanefeld, Johanna; Smith, Richard

2016-01-01

To investigate the magnitude and characteristics of medical tourism in Thailand and the impact of such tourism on the Thai health system and economy. In 2010, we checked the records of all visits to five private hospitals that are estimated to cover 63% of all foreign patients. We reviewed hospital records of foreign patients and obtained data on their countries of origin, diagnoses and interventions. We surveyed 293 medical tourists to collect demographic characteristics and information on their expenditure and travelling companions. To help understand the impact of medical tourism on the Thai health system, we also interviewed 15 hospital executives and 28 service providers from the private hospitals. We obtained 911,913 records of hospital visits, of which 324,906 came from 104,830 medical tourists. We estimated that there were 167,000 medical tourists in Thailand in 2010. Of the medical tourists who attended our study hospitals, 67,987 (64.8%) came from the eastern Mediterranean region or Asia and 109,509 (34%) of them were treated for simple and uncomplicated conditions - i.e. general check-ups and medical consultations. The mean self-reported non-medical expenditure was 2750 United States dollars. According to the hospital staff interviewed, medical tourism in 2010 brought benefits to - and apparently had no negative impacts on - the Thai health system and economy. We estimate that the total number of medical tourists visiting Thailand is about 10% of previous national government estimates of 1.2 million. Such tourists appear to bring economic benefits to Thailand and to have negligible effects on the health system.

Can an online clinical data management service help in improving data collection and data quality in a developing country setting?

NARCIS (Netherlands)

Wildeman, Maarten A.; Zandbergen, Jeroen; Vincent, Andrew; Herdini, Camelia; Middeldorp, Jaap M.; Fles, Renske; Dalesio, Otilia; van der Donk, Emile; Tan, I. Bing

2011-01-01

Data collection by electronic medical record (EMR) systems have been proven to be helpful in data collection for scientific research and in improving healthcare. For a multi-centre trial in Indonesia and the Netherlands a web based system was selected to enable all participating centres to easily

Does the HIPAA Privacy Rule Allow Parents the Right to See Their Children's Medical Records?

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... Does the HIPAA Privacy Rule allow parents the right to see their children’s medical records? Answer: Yes, the Privacy Rule generally ... as the child’s personal representative could endanger the child. Date Created: 12/19/2002 Content ... last reviewed on July 26, 2013 ...

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

Science.gov (United States)

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

2015-04-02

Providers' adoption of electronic health records (EHRs) is increasing and consumers have expressed concerns about the potential effects of EHRs on privacy and security. Yet, we lack a comprehensive understanding regarding factors that affect individuals' perceptions regarding the privacy and security of their medical information. The aim of this study was to describe national perceptions regarding the privacy and security of medical records and identify a comprehensive set of factors associated with these perceptions. Using a nationally representative 2011-2012 survey, we reported on adults' perceptions regarding privacy and security of medical records and sharing of health information between providers, and whether adults withheld information from a health care provider due to privacy or security concerns. We used multivariable models to examine the association between these outcomes and sociodemographic characteristics, health and health care experience, information efficacy, and technology-related variables. Approximately one-quarter of American adults (weighted n=235,217,323; unweighted n=3959) indicated they were very confident (n=989) and approximately half indicated they were somewhat confident (n=1597) in the privacy of their medical records; we found similar results regarding adults' confidence in the security of medical records (very confident: n=828; somewhat confident: n=1742). In all, 12.33% (520/3904) withheld information from a health care provider and 59.06% (2100/3459) expressed concerns about the security of both faxed and electronic health information. Adjusting for other characteristics, adults who reported higher quality of care had significantly greater confidence in the privacy and security of their medical records and were less likely to withhold information from their health care provider due to privacy or security concerns. Adults with higher information efficacy had significantly greater confidence in the privacy and security of medical

Tracking the Implementation of Electronic Medical Records in Dubai, United Arab Emirates, Using an Adoption Benchmarking Tool.

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El-Hassan, Osama; Sharif, Amer; Al Redha, Mohammad; Blair, Iain

2017-01-01

In the United Arab Emirates (UAE), health services have developed greatly in the past 40 years. To ensure they continue to meet the needs of the population, innovation and change are required including investment in a strong e-Health infrastructure with a single transferrable electronic patient record. In this paper, using the Emirate of Dubai as a case study, we report on the Middle East Electronic Medical Record Adoption Model (EMRAM). Between 2011-2016, the number of participating hospitals has increased from 23 to 33. Currently, while 20/33 of hospitals are at Stage 2 or less, 10/33 have reached Stage 5. Also Dubai's median EMRAM score in 2016 (2.5) was higher than the scores reported from Australia (2.2), New Zealand (2.3), Malaysia (0.06), the Philippines (0.06) and Thailand (0.5). EMRAM has allowed the tracking of the progress being made by healthcare facilities in Dubai towards upgrading their information technology infrastructure and the introduction of electronic medical records.

Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature.

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Simons, Sereh M J; Cillessen, Felix H J M; Hazelzet, Jan A

2016-08-02

A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing with the multiplicity of patient problems. The problem list as a precondition is the centerpiece of the problem-oriented medical record (POMR) also called problem-oriented record (POR). Prior to the digital era, paper records presented a flat list of medical problems to the healthcare professional without the features that are possible with current technology. In modern EHRs a POMR based on a structured problem list can be used for clinical decision support, registries, order management, population health, and potentially other innovative functionality in the future, thereby providing a new incentive to the implementation and use of the POMR. On both 12 May 2014 and 1 June 2015 a systematic literature search was conducted. From the retrieved articles statements regarding the POMR and related to successful or non-successful implementation, were categorized. Generic determinants were extracted from these statements. In this research 38 articles were included. The literature analysis led to 12 generic determinants: clinical practice/reasoning, complete and accurate problem list, data structure/content, efficiency, functionality, interoperability, multi-disciplinary, overview of patient information, quality of care, system support, training of staff, and usability. Two main subjects can be distinguished in the determinants: the system that the problem list and POMR is integrated in and the organization using that system. The combination of the two requires a sociotechnical approach and both are equally important for successful implementation of a POMR. All the determinants have to be taken into account, but the weight given to each of the determinants depends on the organizationusing

Inadequate recording of alcohol-drinking, tobacco-smoking and discharge diagnosis in medical in-patients: failure to recognize risks including drug interactions.

Science.gov (United States)

Bairstow, B M; Burke, V; Beilin, L J; Deutscher, C

1993-11-01

The records of 62 men and 43 women, 14-88 years old, admitted to general medical wards in a public teaching hospital during 1991 were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in 22.9% and 21.9% of patients respectively. Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; 10.5% of the patients had interactions involving alcohol and 2.9% tobacco. Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two beta-blockers. The drugs prescribed indicated that some patients had conditions such as gastro-oesophageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed. This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.

Minimally disruptive medicine is needed for patients with multimorbidity: time to develop computerised medical record systems to meet this requirement

Directory of Open Access Journals (Sweden)

Peter Schattner

2015-02-01

Full Text Available Background Minimally disruptive medicine (MDM is proposed as a method for more appropriately managing people with multiple chronic disease. Much clinical management is currently single disease focussed, with people with multimorbidity being managed according to multiple single disease guidelines. Current initiatives to improve care include education about individual conditions and creating an environment where multiple guidelines might be simultaneously supported. The patientcentred medical home (PCMH is an example of the latter. However, educational programmes and PCMH may increase the burden on patients.Problem The cumulative workload for patients in managing the impact of multiple disease-specific guidelines is only relatively recently recognised. There is an intellectual vacuum as to how best to manage multimorbidity and how informatics might support implementing MDM. There is currently no alternative to multiple singlecondition- specific guidelines and a lack of certainty, should the treatment burden need to be reduced, as to which guideline might be ‘dropped’.Action The best information about multimorbidity is recorded in primary care computerised medical record (CMR systems and in an increasing number of integrated care organisations. CMR systems have the potential to flag individuals who might be in greatest need. However, CMR systems may also provide insights into whether there are ameliorating factors that might make it easier for them to be resilient to the burden of care. Data from such CMR systems might be used to develop the evidence base about how to better manage multimorbidity.Conclusions There is potential for these information systems to help reduce the management burden on patients and clinicians. However, substantial investment in research-driven CMR development is needed if we are to achieve this.

An analytical approach to characterize morbidity profile dissimilarity between distinct cohorts using electronic medical records.

Science.gov (United States)

Schildcrout, Jonathan S; Basford, Melissa A; Pulley, Jill M; Masys, Daniel R; Roden, Dan M; Wang, Deede; Chute, Christopher G; Kullo, Iftikhar J; Carrell, David; Peissig, Peggy; Kho, Abel; Denny, Joshua C

2010-12-01

We describe a two-stage analytical approach for characterizing morbidity profile dissimilarity among patient cohorts using electronic medical records. We capture morbidities using the International Statistical Classification of Diseases and Related Health Problems (ICD-9) codes. In the first stage of the approach separate logistic regression analyses for ICD-9 sections (e.g., "hypertensive disease" or "appendicitis") are conducted, and the odds ratios that describe adjusted differences in prevalence between two cohorts are displayed graphically. In the second stage, the results from ICD-9 section analyses are combined into a general morbidity dissimilarity index (MDI). For illustration, we examine nine cohorts of patients representing six phenotypes (or controls) derived from five institutions, each a participant in the electronic MEdical REcords and GEnomics (eMERGE) network. The phenotypes studied include type II diabetes and type II diabetes controls, peripheral arterial disease and peripheral arterial disease controls, normal cardiac conduction as measured by electrocardiography, and senile cataracts. Copyright © 2010 Elsevier Inc. All rights reserved.

A Delphi study among internal medicine clinicians to determine which therapeutic information is essential to record in a medical record.

Science.gov (United States)

van Unen, Robert J; Tichelaar, Jelle; Nanayakkara, Prabath W B; van Agtmael, Michiel A; Richir, Milan C; de Vries, Theo P G M

2015-12-01

Several studies have demonstrated that using a template for recording general and diagnostic information in the medical record (MR) improves the completeness of MR documentation, communication between doctors, and performance of doctors. However, little is known about how therapeutic information should be structured in the MR. The aim of this study was to investigate which specific therapeutic information registrars and consultants in internal medicine consider essential to record in the MR. Therefore, we carried out a 2-round Internet Delphi study. Fifty-nine items were assessed on a 5-point scale; an item was considered important if ≥ 80% of the respondents awarded it a score of 4 or 5. In total, 26 registrars and 30 consultants in internal medicine completed both rounds of the study. Overall, they considered it essential to include information about 11 items in the MR. Subgroup analyses revealed that the registrars considered 8 additional items essential, whereas the consultants considered 1 additional item essential to record. Study findings can be used as a starting point to develop a structured section of the MR for therapeutic information for both paper and electronic MRs. This section should contain at least 11 items considered essential by registrars and clinical consultants in internal medicine. © 2015, The American College of Clinical Pharmacology.

Medical record weight (MRW): a new reliable predictor of hospital stay, morbidity and mortality in the hip fracture population?

LENUS (Irish Health Repository)

Calpin, P

2016-11-01

We sought to compare the weight of patient’s medical records (MRW) to that of standardised surgical risk scoring systems in predicting postoperative hospital stay, morbidity, and mortality in patients with hip fracture. Patients admitted for surgical treatment of a newly diagnosed hip fracture over a 3-month period were enrolled. Patients with documented morbidity or mortality had significantly heavier medical records. The MRW was equivalent to the age-adjusted Charlson co-morbidity index and better than the American Society of Anaesthesiologists physical status score (ASA), the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM,) and Portsmouth-POSSUM score (P-POSSUM) in correlation with length of hospital admission, p = .003, 95% CI [.15 to .65]. Using logistic regression analysis MRW was as good as, if not better, than the other scoring systems at predicting postoperative morbidity and 90-day mortality. Medical record weight is as good as, or better than, validated surgical risk scoring methods. Larger, multicentre studies are required to validate its use as a surgical risk prediction tool, and it may in future be supplanted by a digital measure of electronic record size. Given its ease of use and low cost, it could easily be used in trauma units globally.

Veterinary decision making in relation to metritis - a qualitative approach to understand the background for variation and bias in veterinary medical records

Directory of Open Access Journals (Sweden)

Enevoldsen Carsten

2009-08-01

Full Text Available Abstract Background Results of analyses based on veterinary records of animal disease may be prone to variation and bias, because data collection for these registers relies on different observers in different settings as well as different treatment criteria. Understanding the human influence on data collection and the decisions related to this process may help veterinary and agricultural scientists motivate observers (veterinarians and farmers to work more systematically, which may improve data quality. This study investigates qualitative relations between two types of records: 1 'diagnostic data' as recordings of metritis scores and 2 'intervention data' as recordings of medical treatment for metritis and the potential influence on quality of the data. Methods The study is based on observations in veterinary dairy practice combined with semi-structured research interviews of veterinarians working within a herd health concept where metritis diagnosis was described in detail. The observations and interviews were analysed by qualitative research methods to describe differences in the veterinarians' perceptions of metritis diagnosis (scores and their own decisions related to diagnosis, treatment, and recording. Results The analysis demonstrates how data quality can be affected during the diagnostic procedures, as interaction occurs between diagnostics and decisions about medical treatments. Important findings were when scores lacked consistency within and between observers (variation and when scores were adjusted to the treatment decision already made by the veterinarian (bias. The study further demonstrates that veterinarians made their decisions at 3 different levels of focus (cow, farm, population. Data quality was influenced by the veterinarians' perceptions of collection procedures, decision making and their different motivations to collect data systematically. Conclusion Both variation and bias were introduced into the data because of

[Introduction of computerized anesthesia-recording systems and construction of comprehensive medical information network for patients undergoing surgery in the University of Tokyo Hospital].

Science.gov (United States)

Kitamura, Takayuki; Hoshimoto, Hiroyuki; Yamada, Yoshitsugu

2009-10-01

The computerized anesthesia-recording systems are expensive and the introduction of the systems takes time and requires huge effort. Generally speaking, the efficacy of the computerized anesthesia-recording systems on the anesthetic managements is focused on the ability to automatically input data from the monitors to the anesthetic records, and tends to be underestimated. However, once the computerized anesthesia-recording systems are integrated into the medical information network, several features, which definitely contribute to improve the quality of the anesthetic management, can be developed; for example, to prevent misidentification of patients, to prevent mistakes related to blood transfusion, and to protect patients' personal information. Here we describe our experiences of the introduction of the computerized anesthesia-recording systems and the construction of the comprehensive medical information network for patients undergoing surgery in The University of Tokyo Hospital. We also discuss possible efficacy of the comprehensive medical information network for patients during surgery under anesthetic managements.

Multimedia system for creation, transmission and consultation of medical examination records

International Nuclear Information System (INIS)

Le Rest, C.; Fortineau, J.; Bernier, M.; Guillo, P.; Cavarec, M.

1997-01-01

Achieving an urgency examination requires a rapid transmission of the results to the examiner. An efficient method of their communication could be achieved by producing a multimedia record consisting of images, comments and voiced utterances. We have retained for illustration the case of pulmonary scintigraphy in the diagnosis of pulmonary emboli. Following the acquisition the images are transferred to a PC (under Interfile format). These are displayed on the screen in association with anatomic schemes. In order to present all the elements important for interpretation, a series of tools was developed. Thus, to single out the anomalies the editor is provided with arrows to which verbal comments can be associated. Subsequently, he enters up its record. The interpreted examination is transferred to the examiner's PC via an ATM network. The consultant may then investigate the multimedia record by displaying images and comments and listening to the comments and conclusion of the isotope investigator. A prototype is already operational and its evaluation phase is to start. This stage refers to the quality of transmitted information. A quest among examiners will then allow to evaluate whether the examination reading out and the comprehension of the isotope investigators' conclusions are easier. The speed of transmission will be compared with the current routine (based on manuscript records) and its practical impact in case of urgency circumstances will be assessed. The technical facilities utilized by us allow an easy generalization of the approach to other image-based medical examinations performed in case of urgency

Exposure criteria for medical diagnostic ultrasound: 1, Criteria based on thermal mechanisms

International Nuclear Information System (INIS)

1992-01-01

A previous report (NCRP, 1983) contains a comprehensive review of biological effects and mechanisms of action of ultrasound and an analysis of their implications for medical ultrasound. This Report presents background material for a scientifically-based approach to safety assessment of ultrasound. It is intended to help the medical community take advantage of new developments, while maintaining the excellent safety record which now exists for diagnostic ultrasound

Ethnic differences in cancer symptom awareness and barriers to seeking medical help in England.

Science.gov (United States)

Niksic, Maja; Rachet, Bernard; Warburton, Fiona G; Forbes, Lindsay J L

2016-06-28

Ethnic differences in cancer symptom awareness and barriers to seeking medical help in the English population are not fully understood. We aimed to quantify these differences, to help develop more effective health campaigns, tailored to the needs of different ethnic groups. Using a large national data set (n=38 492) of cross-sectional surveys that used the Cancer Research UK Cancer Awareness Measure, we examined how cancer symptom awareness and barriers varied by ethnicity, controlling for socio-economic position, age and gender. Data were analysed using multivariable logistic regression. Awareness of cancer symptoms was lower in minority ethnic groups than White participants, with the lowest awareness observed among Bangladeshis and Black Africans. Ethnic minorities were more likely than White British to report barriers to help-seeking. South Asians reported the highest emotional barriers, such as lack of confidence to talk to the doctor, and practical barriers, such as worry about many other things. The Irish were more likely than the White British to report practical barriers, such as being too busy to visit a doctor. White British participants were more likely than any other ethnic group to report that they would feel worried about wasting the doctor's time. Overall, Black Africans had the lowest barriers. All differences were statistically significant (Pcancer symptoms among ethnic minorities. Campaigns should tackle the specific barriers prevalent in each ethnic group.

Data Processing and Text Mining Technologies on Electronic Medical Records: A Review

Directory of Open Access Journals (Sweden)

Wencheng Sun

2018-01-01

Full Text Available Currently, medical institutes generally use EMR to record patient’s condition, including diagnostic information, procedures performed, and treatment results. EMR has been recognized as a valuable resource for large-scale analysis. However, EMR has the characteristics of diversity, incompleteness, redundancy, and privacy, which make it difficult to carry out data mining and analysis directly. Therefore, it is necessary to preprocess the source data in order to improve data quality and improve the data mining results. Different types of data require different processing technologies. Most structured data commonly needs classic preprocessing technologies, including data cleansing, data integration, data transformation, and data reduction. For semistructured or unstructured data, such as medical text, containing more health information, it requires more complex and challenging processing methods. The task of information extraction for medical texts mainly includes NER (named-entity recognition and RE (relation extraction. This paper focuses on the process of EMR processing and emphatically analyzes the key techniques. In addition, we make an in-depth study on the applications developed based on text mining together with the open challenges and research issues for future work.

21 CFR 225.102 - Master record file and production records.

Science.gov (United States)

2010-04-01

... or production run of medicated feed to which it pertains. The Master Record File or card shall... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Master record file and production records. 225.102....102 Master record file and production records. (a) The Master Record File provides the complete...

The Use of Hospital Information Systems Data Base with Word Processing and Other Medical Records System Applications

OpenAIRE

Rusnak, James E.

1982-01-01

The approach frequently used to introduce computer technology into a hospital Medical Records Department is to implement a Word Processing System. Word processing is a form of computer system application that is intended to improve the department's productivity by improving the medical information transcription process. The effectiveness of the Word Processing System may be further enhanced by installing system facilities to provide access to data processing file information in the Hospital's...

Electronic medical records in diabetes consultations: participants' gaze as an interactional resource.

Science.gov (United States)

Rhodes, Penny; Small, Neil; Rowley, Emma; Langdon, Mark; Ariss, Steven; Wright, John

2008-09-01

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Medical tourism in Thailand: a cross-sectional study

Science.gov (United States)

Noree, Thinakorn; Hanefeld, Johanna; Smith, Richard

2016-01-01

Abstract Objective To investigate the magnitude and characteristics of medical tourism in Thailand and the impact of such tourism on the Thai health system and economy. Methods In 2010, we checked the records of all visits to five private hospitals that are estimated to cover 63% of all foreign patients. We reviewed hospital records of foreign patients and obtained data on their countries of origin, diagnoses and interventions. We surveyed 293 medical tourists to collect demographic characteristics and information on their expenditure and travelling companions. To help understand the impact of medical tourism on the Thai health system, we also interviewed 15 hospital executives and 28 service providers from the private hospitals. Findings We obtained 911 913 records of hospital visits, of which 324 906 came from 104 830 medical tourists. We estimated that there were 167 000 medical tourists in Thailand in 2010. Of the medical tourists who attended our study hospitals, 67 987 (64.8%) came from the eastern Mediterranean region or Asia and 109 509 (34%) of them were treated for simple and uncomplicated conditions – i.e. general check-ups and medical consultations. The mean self-reported non-medical expenditure was 2750 United States dollars. According to the hospital staff interviewed, medical tourism in 2010 brought benefits to – and apparently had no negative impacts on – the Thai health system and economy. Conclusion We estimate that the total number of medical tourists visiting Thailand is about 10% of previous national government estimates of 1.2 million. Such tourists appear to bring economic benefits to Thailand and to have negligible effects on the health system. PMID:26769994

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.

Brief review: Adoption of electronic medical records to enhance acute pain management.

Science.gov (United States)

Goldstein, David H; Phelan, Rachel; Wilson, Rosemary; Ross-White, Amanda; VanDenKerkhof, Elizabeth G; Penning, John P; Jaeger, Melanie

2014-02-01

The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists' experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada. We first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management. The key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution's process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow. Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.

Progress in electronic medical record adoption in Canada.

Science.gov (United States)

2015-12-01

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

A Technology Acceptance Model for Inter-Organisational Electronic Medical Records Systems

Directory of Open Access Journals (Sweden)

Jocelyn Handy

2001-11-01

Full Text Available This article reports the findings of the first stage of an ongoing, longitudinal study into the implementation of an interorganisational electronic medical records (EMR system. The study adapted and expanded Davis' (1993 technology acceptance model (TAM to investigate the attitudes of primary care practitioners towards a proposed system for maternity patients. All doctors and midwives holding maternity care contracts with a large urban hospital in New Zealand were sent a questionnaire soliciting their views on a planned EMR system linking the hospital and the primary care sectors. The results showed that whilst Davis' two key factors of perceived ease of use and perceived usefulness were important to medical professionals, another key factor, perceived system acceptability, which concerns control and management of information is vitally important to the acceptance of the system. The study also showed that the two groups of professionals had differing requirements due to different levels of experience and practice computerisation. Finally, the research highlights a number of wider organisational issues particularly relevant to the use of inter organisational systems in general and healthcare systems in particular.

Identifying Risk of Future Asthma Attacks Using UK Medical Record Data : A Respiratory Effectiveness Group Initiative

NARCIS (Netherlands)

Blakey, John D.; Price, David B.; Pizzichini, Emilio; Popov, Todor A.; Dimitrov, Borislav D.; Postma, Dirkje S.; Josephs, Lynn K.; Kaplan, Alan; Papi, Alberto; Kerkhof, Marjan; Hillyer, Elizabeth V.; Chisholm, Alison; Thomas, Mike

BACKGROUND: Asthma attacks are common, serious, and costly. Individual factors associated with attacks, such as poor symptom control, are not robust predictors. OBJECTIVE: We investigated whether the rich data available in UK electronic medical records could identify patients at risk of recurrent

Smoking cessation medications

Science.gov (United States)

Smoking cessation - medications; Smokeless tobacco - medications; Medications for stopping tobacco ... Smoking cessation medicines can: Help with the craving for tobacco. Help you with withdrawal symptoms. Keep you ...

Helping mothers survive bleeding after birth

DEFF Research Database (Denmark)

Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

2014-01-01

OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and ambul......OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants...

Implementing change in primary care practices using electronic medical records: a conceptual framework.

Science.gov (United States)

Nemeth, Lynne S; Feifer, Chris; Stuart, Gail W; Ornstein, Steven M

2008-01-16

Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting

Using an electronic medical record to improve communication within a prenatal care network.

Science.gov (United States)

Bernstein, Peter S; Farinelli, Christine; Merkatz, Irwin R

2005-03-01

In 2002, the Institute of Medicine called for the introduction of information technologies in health care settings to improve quality of care. We conducted a review of hospital charts of women who delivered before and after the implementation of an intranet-based computerized prenatal record in an inner-city practice. Our objective was to assess whether the use of this record improved communication among the outpatient office, the ultrasonography unit, and the labor floor. The charts of patients who delivered in August 2002 and August 2003 and received their prenatal care at the Comprehensive Family Care Center at Montefiore Medical Center were analyzed. Data collected included the presence of a copy of the prenatal record in the hospital chart, the date of the last documented prenatal visit, and documentation of any prenatal ultrasonograms performed. Forty-three charts in each group were available for review. The prenatal chart was absent in 16% of the charts of patients from August 2002 compared with only 2% in August 2003 charts (P intranet-based prenatal chart significantly improves communication among providers.

Use of communication tool within electronic medical record to improve primary nonadherence.

Science.gov (United States)

Kerner, Daniel E; Knezevich, Emily L

The primary objective of this study was to determine if an online reminder decreased the rate of primary nonadherence for antihypertensive medications in patients seen in 2 primary care clinics in Omaha, NE. The secondary objectives were to determine if patients receiving the intervention achieved lower blood pressure values at follow-up visits and to determine if the intervention decreased the number of days between prescribing and prescription pick-up. A report was generated in an electronic health record to identify patients prescribed a new antihypertensive medication from a physician at one of the primary care clinics. Patients that failed to pick up this new prescription from the pharmacy within 7 days were sent an electronic reminder via an online patient portal. A baseline comparator group was created with the use of retrospective chart reviews for the 6 months before prospective data collection. Primary nonadherence rate and blood pressure values at follow-up visits were compared between the prospective and baseline comparator groups. The primary nonadherence rate decreased from 65.5% to 22.2% when comparing the baseline and prospective groups, respectively. The mean days to prescription pick-up decreased from 24.5 to 12.56 in the baseline and prospective groups. The prospective group showed a larger decrease in systolic blood pressure (17.33 mm Hg vs. 0.75 mm Hg) and diastolic blood pressure (6.56 mm Hg vs. 2.25 mm Hg) compared with the baseline group. An online reminder through the electronic medical record appears to improve patient primary nonadherence, number of days between prescribing and prescription pick-up, and blood pressure measurements at follow-up visits. This research shows that an online reminder may be a valuable tool to improve patient primary adherence and health outcomes. Further research is needed with the use of a larger sample population to support any hypotheses about the effectiveness of the intervention. Copyright © 2017 American

Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module

Directory of Open Access Journals (Sweden)

Jeffrey Schnipper

2008-07-01

Full Text Available In this article we describe the background, design, and preliminary results of a medications module within Patient Gateway (PG, a patient portal linked to an electronic health record (EHR. The medications module is designed to improve the accuracy of medication lists within the EHR, reduce adverse drug events and improve patient_provider communication regarding medications and allergies in several primary care practices within a large integrated healthcare delivery network. This module allows patients to view and modify the list of medications and allergies from the EHR, report nonadherence, side effects and other medication-related problems and easily communicate this information to providers, who can verify the information and update the EHR as needed. Usage and satisfaction data indicate that patients found the module easy to use, felt that it led to their providers having more accurate information about them and enabled them to feel more prepared for their forthcoming visits. Further analyses will determine the effects of this module on important medication-related outcomes and identify further enhancements needed to improve on this approach.

Gendered Manifestations of Depression and Help Seeking Among Men.

Science.gov (United States)

Call, Jarrod B; Shafer, Kevin

2018-01-01

Men who do not seek help for mental health problems may experience unnecessary suffering which ultimately affects the well-being of themselves and others. Gendered manifestations of depressive symptoms may play an important role in why some men do not seek help for mental health issues. Using data from 2,382 male respondents in the National Comorbidity Survey Replication, the authors examined the relationship that both traditional and male-typical symptoms of depression had on the help-seeking behaviors of men. Traditional symptoms increased the odds of seeking help for depression for all men. Male-typical symptoms, however, did not increase the odds of seeking help for depression or another mental health concern. Both traditional and male-typical symptoms increased the odds of initially seeking help from a medical provider, and men with male-typical symptoms had an overall higher likelihood of seeking help from a medical provider. Consequently, it is important that medical professionals assess for depression even when it is not a presenting concern.

[End-of-life-care and euthanasia: medical assistance in dying or help to die].

Science.gov (United States)

Müller-Busch, H Christof

2008-01-01

The debate on euthanasia that has been started all over Europe, but especially in Germany has been particularly complicated by unclear and inconsistent definitions. Medical decisions in end-of-life care gain increasing importance not only for the time of death but also for the kind and quality of the dying process. Though legal regulations can help to diminish doubts about the permissibility of various measures in end-of-life care, teaching and knowledge of ethical principles, communication skills, respect, transparency and knowledge of palliative care options seem to be the most important factors in accompanying the dying professionally and with dignity and even in achieving a consented compromise when aid in hastening death is asked for.

Technical Executive Summary in Support of "Can Electronic Medical Record Systems Transform Healthcare?" and "Promoting Health Information Technology"

National Research Council Canada - National Science Library

Bigelow, James H; Fonkych, Kateryna; Girosi, Federico

2005-01-01

.... The three sections of this paper summarize these documents in the order listed. Report no. 1 estimates the degree to which hospitals and physician practices have adopted electronic medical records (EMRs...

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

Science.gov (United States)

Winkelman, Warren J; Leonard, Kevin J

2004-01-01

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

Identification of fall predictors in the active elderly population from the routine medical records of general practitioners.

Science.gov (United States)

Lastrucci, Vieri; Lorini, Chiara; Rinaldi, Giada; Bonaccorsi, Guglielmo

2018-03-01

Aim To evaluate the possibility of determining predictors of falls in the active community-dwelling elderly from the routine medical records of the general practitioners (GPs). Time constraints and competing demands in the clinical encounters frequently undermine fall-risk evaluation. In the context of proactive primary healthcare, quick, and efficient tools for a preliminary fall-risk assessment are needed in order to overcome these barriers. The study included 1220 subjects of 65 years of age or older. Data were extracted from the GPs' patient records. For each subject, the following variables were considered: age, gender, diseases, and pharmacotherapy. Univariate and multivariable analyses have been conducted to identify the independent predictors of falls. Findings The mean age of the study population was 77.8±8.7 years for women and 74.9±7.3 years for men. Of the sample, 11.6% had experienced one or more falls in the previous year. The risk of falling was found to increase significantly (P<0.05) with age (OR=1.03; 95% CI=1.01-1.05), generalized osteoarthritis (OR=2.01; 95% CI=1.23-3.30), tinnitus (OR=4.14; 95% CI=1.25-13.74), cognitive impairment (OR=4.12; 95% CI=2.18-7.80), and two or more co-existing diseases (OR=5.4; 95% CI=1.68-17.39). Results suggest that it is possible to identify patients at higher risk of falling by going through the current medical records, without adding extra workload on the health personnel. In the context of proactive primary healthcare, the analysis of fall predictors from routine medical records may allow the identification of which of the several known and hypothesized risk factors may be more relevant for developing quick and efficient tools for a preliminary fall-risk assessment.

Incidence of Traumatic Brain Injury Across the Full Disease Spectrum: A Population-Based Medical Record Review Study

Science.gov (United States)

Leibson, Cynthia L.; Brown, Allen W.; Ransom, Jeanine E.; Diehl, Nancy N.; Perkins, Patricia K.; Mandrekar, Jay; Malec, James F.

2012-01-01

Background Extremely few objective estimates of traumatic brain injury incidence include all ages, both sexes, all injury mechanisms, and the full spectrum from very mild to fatal events. Methods We used unique Rochester Epidemiology Project medical records-linkage resources, including highly sensitive and specific diagnostic coding, to identify all Olmsted County, MN, residents with diagnoses suggestive of traumatic brain injury regardless of age, setting, insurance, or injury mechanism. Provider-linked medical records for a 16% random sample were reviewed for confirmation as definite, probable, possible (symptomatic), or no traumatic brain injury. We estimated incidence per 100,000 person-years for 1987–2000 and compared these record-review rates with rates obtained using Centers for Disease Control and Prevention (CDC) data-systems approach. For the latter, we identified all Olmsted County residents with any CDC-specified diagnosis codes recorded on hospital/emergency department administrative claims or death certificates 1987–2000. Results Of sampled individuals, 1257 met record-review criteria for incident traumatic brain injury; 56% were ages 16–64 years, 56% were male, 53% were symptomatic. Mechanism, sex, and diagnostic certainty differed by age. The incidence rate per 100,000 person-years was 558 (95% confidence interval = 528–590) versus 341 (331–350) using the CDC data system approach. The CDC approach captured only 40% of record-review cases. Seventy-four percent of missing cases presented to hospital/emergency department; none had CDC-specified codes assigned on hospital/emergency department administrative claims or death certificates; 66% were symptomatic. Conclusions Capture of symptomatic traumatic brain injuries requires a wider range of diagnosis codes, plus sampling strategies to avoid high rates of false-positive events. PMID:21968774

IMASIS computer-based medical record project: dealing with the human factor.

Science.gov (United States)

Martín-Baranera, M; Planas, I; Palau, J; Sanz, F

1995-01-01

The Institut Municipal d'Assistència Sanitària (IMAS) is a health care organization in Barcelona, comprising two general hospitals, a psychiatric hospital, a surgical clinic, a geriatric center, some primary care clinics, and a research institute. Since 1984, IMAS has been engaged in creating a multicenter integrated hospital information system (IMASIS). Currently, IMASIS offers the possibility to manage administrative data, laboratory results, pathology and cytology reports, radiology reports, and pharmacy inpatient orders; it also shares this information on-line among IMAS centers. IMASIS users may also work with a word processor, a spreadsheet, a database, or a statistical package and have access to MEDLINE. A second phase of IMASIS development began in December 1993 focused on clinical information management. The goal was to move towards an integrated multimedia medical record [1]. As a first step, the implementation experiences of the most advanced hospital information systems around the world were studied. Some of these experiences detected behavioral, cultural, and organizational factors [2] as the main sources of delay, or even failure, in HIS projects. A preliminary analysis to define such factors, assess their potential impact, and introduce adequate measures to deal with them seemed unavoidable before structuring of the project. In our approach to physician attitudes analysis, two survey techniques were applied. First, every hospital service head was contacted to schedule an interview, with either a service representative or a group of staff physicians and residents. The aim was to provide detailed information about project objectives and collect personal opinions, problems encountered in the current HIS, and specific needs of every medical and surgical specialty (including imaging needs). Every service head was asked to distribute a questionnaire among all clinicians, which assessed frequency of use of IMASIS current applications, user's satisfaction

CERN's role in medical applications

CERN Multimedia

Antonella Del Rosso

2014-01-01

Last week, CERN hosted the first meeting of the International Strategy Committee for medical applications. This Committee will help CERN establish its roadmap in the field of research and development activities for medical applications. Here the CERN Bulletin speaks with the Chair of the Committee as he shares his expectations and his vision.   Dr Michael Baumann is the Director of the Radiation Oncology department at the Carl Gustav Carus University Hospital in Dresden and of the Institute for Radiooncology of the Helmholtz-Zentrum Dresden-Rossendorf (Germany). He has recently been appointed Chair of CERN’s International Strategy Committee for medical applications – the team of experts who will advise the CERN Medical Applications Study Group led by Steve Myers. “CERN has a tremendous record in physics and basic research,” says Baumann. “I think that it has a very important role in steering some of the R&D that cannot be done at universities ...

[Audit as a tool to assess and promote the quality of medical records and hospital appropriateness: metodology and preliminary results].

Science.gov (United States)

Poscia, Andrea; Cambieri, Andrea; Tucceri, Chiara; Ricciardi, Walter; Volpe, Massimo

2015-01-01

In the actual economic context, with increasing health needs, efficiency and efficacy represents fundamental keyword to ensure a successful use of the resources and the best health outcomes. Together, the medical record, completely and correctly compiled, is an essential tool in the patient diagnostic and therapeutic path, but it's becoming more and more essential for the administrative reporting and legal claims. Nevertheless, even if the improvement of medical records quality and of hospital stay appropriateness represent priorities for every health organization, they could be difficult to realize. This study aims to present the methodology and the preliminary results of a training and improvement process: it was carried out from the Hospital Management of a third level Italian teaching hospital through audit cycles to actively involve their health professionals. A self assessment process of medical records quality and hospital stay appropriateness (inpatients admission and Day Hospital) was conducted through a retrospective evaluation of medical records. It started in 2012 and a random sample of 2295 medical records was examined: the quality assessment was performed using a 48-item evaluation grid modified from the Lombardy Region manual of the medical record, while the appropriateness of each days was assessed using the Italian version of Appropriateness Evaluation Protocol (AEP) - 2002ed. The overall assessment was presented through departmental audit: the audit were designed according to the indication given by the Italian and English Ministry of Health to share the methodology and the results with all the involved professionals (doctors and nurses) and to implement improvement strategies that are synthesized in this paper. Results from quality and appropriateness assessment show several deficiencies, due to 40% of minimum level of acceptability not completely satisfied and to 30% of inappropriateness between days of hospitalization. Furthermore, there are

Medical records department and balanced scorecard approach.

Science.gov (United States)

Ajami, Sima; Ebadsichani, Afsaneh; Tofighi, Shahram; Tavakoli, Nahid

2013-01-01

The Medical Records Department (MRD) is an important source for evaluating and planning of healthcare services; therefore, hospital managers should improve their performance not only in the short-term but also in the long-term plans. The Balanced Scorecard (BSC) is a tool in the management system that enables organizations to correct operational functions and provides feedback around both the internal processes and the external outcomes, in order to improve strategic performance and outcomes continuously. The main goal of this study was to assess the MRD performance with BSC approach in a hospital. This research was an analytical cross-sectional study in which data was collected by questionnaires, forms and observation. The population was the staff of the MRD in a hospital in Najafabad, Isfahan, Iran. To analyze data, first, objectives of the MRD, according to the mission and perspectives of the hospital, were redefined and, second, indicators were measured. Subsequently, findings from the performance were compared with the expected score. In order to achieve the final target, the programs, activities, and plans were reformed. The MRD was successful in absorbing customer satisfaction. From a customer perspective, score in customer satisfaction of admission and statistics sections were 82% and 83%, respectively. The comprehensive nature of the strategy map makes the MRD especially useful as a consensus building and communication tool in the hospital.

Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

NARCIS (Netherlands)

Boonstra, Albert; Broekhuis, Manda

2010-01-01

Background: The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options. Methods: A systematic literature review, based on

Detecting inpatient falls by using natural language processing of electronic medical records

Directory of Open Access Journals (Sweden)

Toyabe Shin-ichi

2012-12-01

Full Text Available Abstract Background Incident reporting is the most common method for detecting adverse events in a hospital. However, under-reporting or non-reporting and delay in submission of reports are problems that prevent early detection of serious adverse events. The aim of this study was to determine whether it is possible to promptly detect serious injuries after inpatient falls by using a natural language processing method and to determine which data source is the most suitable for this purpose. Methods We tried to detect adverse events from narrative text data of electronic medical records by using a natural language processing method. We made syntactic category decision rules to detect inpatient falls from text data in electronic medical records. We compared how often the true fall events were recorded in various sources of data including progress notes, discharge summaries, image order entries and incident reports. We applied the rules to these data sources and compared F-measures to detect falls between these data sources with reference to the results of a manual chart review. The lag time between event occurrence and data submission and the degree of injury were compared. Results We made 170 syntactic rules to detect inpatient falls by using a natural language processing method. Information on true fall events was most frequently recorded in progress notes (100%, incident reports (65.0% and image order entries (12.5%. However, F-measure to detect falls using the rules was poor when using progress notes (0.12 and discharge summaries (0.24 compared with that when using incident reports (1.00 and image order entries (0.91. Since the results suggested that incident reports and image order entries were possible data sources for prompt detection of serious falls, we focused on a comparison of falls found by incident reports and image order entries. Injury caused by falls found by image order entries was significantly more severe than falls detected by

Help of third-year medical students decreases first-year medical students' negative psychological reactions on the first day of gross anatomy dissection.

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Houwink, Aletta P; Kurup, Anil N; Kollars, Joshua P; Kral Kollars, Catharine A; Carmichael, Stephen W; Pawlina, Wojciech

2004-05-01

The assistance of third-year medical students (MS3) may be an easy, inexpensive, educational method to decrease physical and emotional stress among first-year medical students (MS1) on the first day of gross anatomy dissection. In the academic years 2000-2001 and 2001-2002, a questionnaire on the emotional and physical reactions on the first day of dissection was distributed to 84 MS1 at Mayo Medical School (Rochester, MN); 74 (88%) responded. Student perceptions were assessed on a 5-point Likert scale. The 42 second-year medical students (MS2) whose first academic year was 1999-2000 were used as a control group, because they had not had assistance from MS3. MS2 completed the same questionnaire (59% response rate). Data were collected from MS1 on the day of their first gross anatomy dissection. The most frequent reactions were headache, disgust, grief or sadness, and feeling light-headed. Significant differences (alpha vs. 88%), reporting lower levels of anxiety (23% vs. 48%), headache (14% vs. 36%), disgust (9% vs. 20%), feeling light-headed (11% vs. 24%), and reaction to the smell of the cadaver and laboratory (8% vs. 52%). MS1 commented that having MS3 at the dissection table was extremely helpful. They relied less on their peers and felt they learned more efficiently about the dissection techniques and anatomical structures. Using MS3 as assistants is one method to reduce fear and anxiety on the first day of gross anatomy dissection. Copyright 2004 Wiley-Liss, Inc.

SynopSIS: integrating physician sign-out with the electronic medical record.

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Sarkar, Urmimala; Carter, Jonathan T; Omachi, Theodore A; Vidyarthi, Arpana R; Cucina, Russell; Bokser, Seth; van Eaton, Erik; Blum, Michael

2007-09-01

Safe delivery of care depends on effective communication among all health care providers, especially during transfers of care. The traditional medical chart does not adequately support such communication. We designed a patient-tracking tool that enhances provider communication and supports clinical decision making. To develop a problem-based patient-tracking tool, called Sign-out, Information Retrieval, and Summary (SynopSIS), in order to support patient tracking, transfers of care (ie, sign-outs), and daily rounds. Tertiary-care, university-based teaching hospital. SynopSIS compiles and organizes information from the electronic medical record to support hospital discharge and disposition decisions, daily provider decisions, and overnight or cross-coverage decisions. It reflects the provider's patient-care and daily work-flow needs. We plan to use Web-based surveys, audits of daily use, and interdisciplinary focus groups to evaluate SynopSIS's impact on communication between providers, quality of sign-out, patient continuity of care, and rounding efficiency. We expect SynopSIS to improve care by facilitating communication between care teams, standardizing sign-out, and automating daily review of clinical and laboratory trends. SynopSIS redesigns the clinical chart to better serve provider and patient needs. (c) 2007 Society of Hospital Medicine.

An analysis of the recording of tobacco use among inpatients in Irish hospitals.

LENUS (Irish Health Repository)

Sheridan, A

2014-10-01

Smoking is the largest avoidable cause of premature mortality in the world. Hospital admission is an opportunity to identify and help smokers quit. This study aimed to determine the level of recording of tobacco use (current and past) in Irish hospitals. Information on inpatient discharges with a tobacco use diagnosis was extracted from HIPE. In 2011, a quarter (n=84, 679) of discharges had a recording of tobacco use, which were more common among males (29% (n=50,161) male v. 20% (n=30,162) female), among medical patients (29% (n=54,375) medical v. 20% (n=30,162) other) and was highest among those aged 55-59 years (30.6%; n=7,885). SLAN 2007 reported that 48% of adults had smoked at some point in their lives. This study would suggest an under- reporting of tobacco use among hospital inpatients. Efforts should be made to record smoking status at hospital admission, and to improve the quality of the HIPE coding of tobacco use.

Evaluating privacy-preserving record linkage using cryptographic long-term keys and multibit trees on large medical datasets.

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Brown, Adrian P; Borgs, Christian; Randall, Sean M; Schnell, Rainer

2017-06-08

Integrating medical data using databases from different sources by record linkage is a powerful technique increasingly used in medical research. Under many jurisdictions, unique personal identifiers needed for linking the records are unavailable. Since sensitive attributes, such as names, have to be used instead, privacy regulations usually demand encrypting these identifiers. The corresponding set of techniques for privacy-preserving record linkage (PPRL) has received widespread attention. One recent method is based on Bloom filters. Due to superior resilience against cryptographic attacks, composite Bloom filters (cryptographic long-term keys, CLKs) are considered best practice for privacy in PPRL. Real-world performance of these techniques using large-scale data is unknown up to now. Using a large subset of Australian hospital admission data, we tested the performance of an innovative PPRL technique (CLKs using multibit trees) against a gold-standard derived from clear-text probabilistic record linkage. Linkage time and linkage quality (recall, precision and F-measure) were evaluated. Clear text probabilistic linkage resulted in marginally higher precision and recall than CLKs. PPRL required more computing time but 5 million records could still be de-duplicated within one day. However, the PPRL approach required fine tuning of parameters. We argue that increased privacy of PPRL comes with the price of small losses in precision and recall and a large increase in computational burden and setup time. These costs seem to be acceptable in most applied settings, but they have to be considered in the decision to apply PPRL. Further research on the optimal automatic choice of parameters is needed.

Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group.

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Liyanage, Harshana; Liaw, Siaw-Teng; Konstantara, Emmanouela; Mold, Freda; Schreiber, Richard; Kuziemsky, Craig; Terry, Amanda L; de Lusignan, Simon

2018-04-22

 Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs.  To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM).  A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements.  Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements.  Patients' online access to their CMRs should be part of all CMR systems. It improves the process

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

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

2018-05-28

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

Effectively marketing prepaid medical care with decision support systems.

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Forgionne, G A

1991-01-01

The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches.

The use of electronic patient records for medical research: conflicts and contradictions.

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Stevenson, Fiona

2015-03-29

The use of electronic patient records for medical research is extremely topical. The Clinical Practice Research Datalink (CRPD), the English NHS observational data and interventional research service, was launched in April 2012. The CPRD has access to, and facilities to link, many healthcare related datasets. The CPRD is partially based on learning from the Health Research Support Service (HRSS), which was used to test the technical and practical aspects of downloading and linking electronic patient records for research. Questions around the feasibility and acceptability of implementing and integrating the processes necessary to enable electronic patient records to be used for the purposes of research remain. Focus groups and interviews were conducted with a total of 50 patients and 7 staff from the two English GP practices involved in piloting the HRSS, supplemented with 11 interviews with key stakeholders. Emergent themes were mapped on to the constructs of normalization process theory (NPT) to consider the ways in which sense was made of the work of implementing and integrating the HRSS. The NPT analysis demonstrated a lack of commitment to, and engagement with, the HRSS on the part of patients, whilst the commitment of doctors and practice staff was to some extent mitigated by concerns about issues of governance and consent, particularly in relation to downloading electronic patient records with associated identifiers. Although the CPRD is presented as a benign, bureaucratic process, perceptions by patients and staff of inherent contradictions with centrally held values of information governance and consent in downloading and linking electronic patient records for research remains a barrier to implementation. It is likely that conclusions reached about the problems of balancing the contradictions inherent in sharing what can be perceived as a private resource for the public good are globally transferrable.

What information is provided in transcripts and Medical Student Performance Records from Canadian Medical Schools? A retrospective cohort study.

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Robins, Jason A; McInnes, Matthew D F; Esmail, Kaisra

2014-01-01

Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates' documentation, the heterogeneity therein, as well as its objective data. Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.

What information is provided in transcripts and Medical Student Performance Records from Canadian Medical Schools? A retrospective cohort study

Directory of Open Access Journals (Sweden)

Jason A. Robins

2014-09-01

Full Text Available Background: Resident selection committees must rely on information provided by medical schools in order to evaluate candidates. However, this information varies between institutions, limiting its value in comparing individuals and fairly assessing their quality. This study investigates what is included in candidates’ documentation, the heterogeneity therein, as well as its objective data. Methods: Samples of recent transcripts and Medical Student Performance Records were anonymised prior to evaluation. Data were then extracted by two independent reviewers blinded to the submitting university, assessing for the presence of pre-selected criteria; disagreement was resolved through consensus. The data were subsequently analysed in multiple subgroups. Results: Inter-rater agreement equalled 92%. Inclusion of important criteria varied by school, ranging from 22.2% inclusion to 70.4%; the mean equalled 47.4%. The frequency of specific criteria was highly variable as well. Only 17.7% of schools provided any basis for comparison of academic performance; the majority detailed only status regarding pass or fail, without any further qualification. Conclusions: Considerable heterogeneity exists in the information provided in official medical school documentation, as well as markedly little objective data. Standardization may be necessary in order to facilitate fair comparison of graduates from different institutions. Implementation of objective data may allow more effective intra- and inter-scholastic comparison.

21 CFR 226.110 - Distribution records.

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2010-04-01

...: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR TYPE A MEDICATED ARTICLES Records and Reports § 226.110 Distribution records. Complete records shall be maintained for each shipment of Type A medicated article(s) in... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Distribution records. 226.110 Section 226.110 Food...

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record.

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Biagioli, Frances E; Elliot, Diane L; Palmer, Ryan T; Graichen, Carla C; Rdesinski, Rebecca E; Ashok Kumar, Kaparaboyna; Galper, Ari B; Tysinger, James W

2017-01-01

Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. The authors collected performance data for students (n = 71) at the first institution during academic years 2011-2013 and for students (n = 211) at the second institution during academic year 2013-2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students' EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Cross-institutional data comparisons will help determine whether differences in curricula affect students' EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.

Opportunities for Enhanced Strategic Use of Surveys, Medical Records, and Program Data for HIV Surveillance of Key Populations: Scoping Review

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Baral, Stefan D; Edwards, Jessie K; Zadrozny, Sabrina; Hargreaves, James; Zhao, Jinkou; Sabin, Keith

2018-01-01

Background Normative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately. Objective The aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs. Methods To provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched. Results There remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and

[Electronic medical records: Evolution of physician-patient relationship in the Primary Care clinic].

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Pérez-Santonja, T; Gómez-Paredes, L; Álvarez-Montero, S; Cabello-Ballesteros, L; Mombiela-Muruzabal, M T

2017-04-01

The introduction of electronic medical records and computer media in clinics, has influenced the physician-patient relationship. These modifications have many advantages, but there is concern that the computer has become too important, going from a working tool to the centre of our attention during the clinical interview, decreasing doctor interaction with the patient. The objective of the study was to estimate the percentage of time that family physicians spend on computer media compared to interpersonal communication with the patient, and whether this time is modified depending on different variables such as, doctor's age or reason for the consultation. An observational and descriptive study was conducted for 10 weeks, with 2 healthcare centres involved. The researchers attended all doctor- patient interviews, recording the patient time in and out of the consultation. Each time the doctor fixed his gaze on computer media the time was clocked. A total of 436 consultations were collected. The doctors looked at the computer support a median 38.33% of the total duration of an interview. Doctors of 45 years and older spent more time fixing their eyes on computer media (P<.05). Family physicians used almost 40% of the consultation time looking at computer media, and depends on age of physician, number of queries, and number of medical appointments. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial.

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Clark, Lucy V; Pesola, Francesca; Thomas, Janice M; Vergara-Williamson, Mario; Beynon, Michelle; White, Peter D

2017-07-22

Graded exercise therapy is an effective and safe treatment for chronic fatigue syndrome, but it is therapist intensive and availability is limited. We aimed to test the efficacy and safety of graded exercise delivered as guided self-help. In this pragmatic randomised controlled trial, we recruited adult patients (18 years and older) who met the UK National Institute for Health and Care Excellence criteria for chronic fatigue syndrome from two secondary-care clinics in the UK. Patients were randomly assigned to receive specialist medical care (SMC) alone (control group) or SMC with additional guided graded exercise self-help (GES). Block randomisation (randomly varying block sizes) was done at the level of the individual with a computer-generated sequence and was stratified by centre, depression score, and severity of physical disability. Patients and physiotherapists were necessarily unmasked from intervention assignment; the statistician was masked from intervention assignment. SMC was delivered by specialist doctors but was not standardised; GES consisted of a self-help booklet describing a six-step graded exercise programme that would take roughly 12 weeks to complete, and up to four guidance sessions with a physiotherapist over 8 weeks (maximum 90 min in total). Primary outcomes were fatigue (measured by the Chalder Fatigue Questionnaire) and physical function (assessed by the Short Form-36 physical function subscale); both were self-rated by patients at 12 weeks after randomisation and analysed in all randomised patients with outcome data at follow-up (ie, by modified intention to treat). We recorded adverse events, including serious adverse reactions to trial interventions. We used multiple linear regression analysis to compare SMC with GES, adjusting for baseline and stratification factors. This trial is registered at ISRCTN, number ISRCTN22975026. Between May 15, 2012, and Dec 24, 2014, we recruited 211 eligible patients, of whom 107 were assigned to the

Web tools for effective retrieval, visualization, and evaluation of cardiology medical images and records

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Masseroli, Marco; Pinciroli, Francesco

2000-12-01

To provide easy retrieval, integration and evaluation of multimodal cardiology images and data in a web browser environment, distributed application technologies and java programming were used to implement a client-server architecture based on software agents. The server side manages secure connections and queries to heterogeneous remote databases and file systems containing patient personal and clinical data. The client side is a Java applet running in a web browser and providing a friendly medical user interface to perform queries on patient and medical test dat and integrate and visualize properly the various query results. A set of tools based on Java Advanced Imaging API enables to process and analyze the retrieved cardiology images, and quantify their features in different regions of interest. The platform-independence Java technology makes the developed prototype easy to be managed in a centralized form and provided in each site where an intranet or internet connection can be located. Giving the healthcare providers effective tools for querying, visualizing and evaluating comprehensively cardiology medical images and records in all locations where they can need them- i.e. emergency, operating theaters, ward, or even outpatient clinics- the developed prototype represents an important aid in providing more efficient diagnoses and medical treatments.

Medical tourism: the trend toward outsourcing medical procedures to foreign countries.

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York, Diane

2008-01-01

The rising costs of medical treatment in the United States are fueling a movement to outsource medical treatment. Estimates of the number of Americans traveling overseas for treatment range from 50,000 to 500,000. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee replacement in the United States can cost $40,000 compared to $13,000 in Singapore.A new industry, medical tourism, has been created to advise patients on the appropriate facility in the right country for their condition, handle all travel arrangements, teleconference with physicians, and send medical records. To respond to the growth in medical travel, the Joint Commission (formerly the Joint Commission on Accreditation of Health Care Organizations) initiated the Joint Commission International (JCI) to accredit hospitals worldwide. Although outcome statistics from hospitals outside the United States are rare, first-person reports on quality are numerous. Making surgery possible for uninsured and underinsured individuals or self-insured state, municipal, and private entities is a major benefit of medical tourism. Mitigating against medical travel are the lack of legal remedies in place for malpractice and the possibility that travel itself can impose risk to patients. For example, lengthy air flights where the patient is in a fixed position for hours at a time can cause embolisms. If the trend toward medical tourism continues, continuing education, credentialing, and certification services may be required to help assure patient safety.

Med-records: an ADD database of AAEC medical records since 1966

International Nuclear Information System (INIS)

Barry, J.M.; Pollard, J.P.; Tucker, A.D.

1986-08-01

Since its inception in 1958 most of the staff of the AAEC Research Establishment at Lucas Heights have had annual medical examinations. Medical information accrued since 1966 has been collected as an ADD database to allow ad hoc enquiries to be made against the data. Details are given of the database schema and numerous support routines ranging from the integrity checking of input data to analysis and plotting of the summary results

Implementing and Integrating a Clinically-Driven Electronic Medical Record (EMR for Radiation Oncology in a Large Medical Enterprise

Directory of Open Access Journals (Sweden)

John Paxton Kirkpatrick

2013-04-01

Full Text Available Purpose/Objective: While our department is heavily invested in computer-based treatment planning, we historically relied on paper-based charts for management of Radiation Oncology patients. In early 2009, we initiated the process of conversion to an electronic medical record (EMR eliminating the need for paper charts. Key goals included the ability to readily access information wherever and whenever needed, without compromising safety, treatment quality, confidentiality or productivity.Methodology: In February, 2009, we formed a multi-disciplinary team of Radiation Oncology physicians, nurses, therapists, administrators, physicists/dosimetrists, and information technology (IT specialists, along with staff from the Duke Health System IT department. The team identified all existing processes and associated information/reports, established the framework for the EMR system and generated, tested and implemented specific EMR processes.Results: Two broad classes of information were identified: information which must be readily accessed by anyone in the health system versus that used solely within the Radiation Oncology department. Examples of the former are consultation reports, weekly treatment check notes and treatment summaries; the latter includes treatment plans, daily therapy records and quality assurance reports. To manage the former, we utilized the enterprise-wide system , which required an intensive effort to design and implement procedures to export information from Radiation Oncology into that system. To manage "Radiation Oncology" data, we used our existing system (ARIA, Varian Medical Systems. The ability to access both systems simultaneously from a single workstation (WS was essential, requiring new WS and modified software. As of January, 2010, all new treatments were managed solely with an EMR. We find that an EMR makes information more widely accessible and does not compromise patient safety, treatment quality or confidentiality

[Medical intern or locum doctor--does job position affect learning?].

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Mars, Nina; Kalske, Jaakko; Halttunen-Nieminen, Mervi; Pitkäranta, Anne

2015-01-01

At the University of Helsinki, the licentiate degree in medicine involves internships that can be conducted as a medical intern or locum doctor. The students and their supervisors fill out a feedback form, which helps in assessing the students' improvement in various areas. Based on the feedback form between 2008 and 2013, students having worked as locum doctor rated better improvement in their diagnostic skills, writing medical records, interacting with the patient, and operating in the work community. Supervisor evaluations did not show a similar clear difference between the job positions.

Does Wearable Medical Technology With Video Recording Capability Add Value to On-Call Surgical Evaluations?

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Gupta, Sameer; Boehme, Jacqueline; Manser, Kelly; Dewar, Jannine; Miller, Amie; Siddiqui, Gina; Schwaitzberg, Steven D

2016-10-01

Background Google Glass has been used in a variety of medical settings with promising results. We explored the use and potential value of an asynchronous, near-real time protocol-which avoids transmission issues associated with real-time applications-for recording, uploading, and viewing of high-definition (HD) visual media in the emergency department (ED) to facilitate remote surgical consults. Study Design First-responder physician assistants captured pertinent aspects of the physical examination and diagnostic imaging using Google Glass' HD video or high-resolution photographs. This visual media were then securely uploaded to the study website. The surgical consultation then proceeded over the phone in the usual fashion and a clinical decision was made. The surgeon then accessed the study website to review the uploaded video. This was followed by a questionnaire regarding how the additional data impacted the consultation. Results The management plan changed in 24% (11) of cases after surgeons viewed the video. Five of these plans involved decision making regarding operative intervention. Although surgeons were generally confident in their initial management plan, confidence scores increased further in 44% (20) of cases. In addition, we surveyed 276 ED patients on their opinions regarding concerning the practice of health care providers wearing and using recording devices in the ED. The survey results revealed that the majority of patients are amenable to the addition of wearable technology with video functionality to their care. Conclusions This study demonstrates the potential value of a medically dedicated, hands-free, HD recording device with internet connectivity in facilitating remote surgical consultation. © The Author(s) 2016.

Sharing and helping: predictors of adolescents' willingness to share diabetes personal health information with peers.

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Vaala, Sarah E; Lee, Joyce M; Hood, Korey K; Mulvaney, Shelagh A

2018-02-01

Sharing personal information about type 1 diabetes (T1D) can help adolescents obtain social support, enhance social learning, and improve self-care. Diabetes technologies, online communities, and health interventions increasingly feature data-sharing components. This study examines factors underlying adolescents' willingness to share personal T1D information with peers. Participants were 134 adolescents (12-17 years of age; 56% female) who completed an online survey regarding experiences helping others with T1D, perceived social resources, beliefs about the value of sharing information and helping others, and willingness to share T1D information. Hemoglobin A1c values were obtained from medical records. Adolescents were more willing to share how they accomplished T1D tasks than how often they completed them, and least willing to share glucose control status. In multivariate analyses, sharing/helping beliefs (β = 0.26, P value; β = -0.26, P personal health information. Glucose control moderated relationships such that adolescents with worse A1c values had stronger relationships between sharing/helping beliefs and willingness to share (β = 0.18, P personal health information, particularly if they have better diabetes health status and a stronger belief in the benefits of sharing. Social learning and social media components may improve intervention participation, engagement, and outcomes by boosting adolescents' beliefs about the benefits of sharing information and helping others. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

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

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

2017-11-01

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

An analytical approach to characterize morbidity profile dissimilarity between distinct cohorts using electronic medical records

OpenAIRE

Schildcrout, Jonathan S.; Basford, Melissa A.; Pulley, Jill M.; Masys, Daniel R.; Roden, Dan M.; Wang, Deede; Chute, Christopher G.; Kullo, Iftikhar J.; Carrell, David; Peissig, Peggy; Kho, Abel; Denny, Joshua C.

2010-01-01

We describe a two-stage analytical approach for characterizing morbidity profile dissimilarity among patient cohorts using electronic medical records. We capture morbidities using the International Statistical Classification of Diseases and Related Health Problems (ICD-9) codes. In the first stage of the approach separate logistic regression analyses for ICD-9 sections (e.g., “hypertensive disease” or “appendicitis”) are conducted, and the odds ratios that describe adjusted differences in pre...

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

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

2010-01-01

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

Validation of metabolic syndrome using medical records in the SUN cohort

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Barrio-Lopez Maria

2011-11-01

Full Text Available Abstract Background The objective of this study was to evaluate the validity of self reported criteria of Metabolic Syndrome (MS in the SUN (Seguimiento Universidad de Navarra cohort using their medical records as the gold standard. Methods We selected 336 participants and we obtained MS related data according to Adult Treatment Panel III (ATP III and International Diabetes Federation (IDF. Then we compared information on the self reported diagnosis of MS and MS diagnosed in their medical records. We calculated the proportion of confirmed MS, the proportion of confirmed non-MS and the intraclass correlation coefficients for each component of the MS. Results From those 336 selected participants, we obtained sufficient data in 172 participants to confirm or reject MS using ATP III criteria. The proportion of confirmed MS was 91.2% (95% CI: 80.7- 97.1 and the proportion of confirmed non-MS was 92.2% (95% CI: 85.7-96.4 using ATP III criteria. The proportion of confirmed MS using IDF criteria was 100% (95% CI: 87.2-100 and the proportion of confirmed non-MS was 97.1% (95% CI: 85.1-99.9. Kappa Index was 0.82 in the group diagnosed by ATP III criteria and 0.97 in the group diagnosed by IDF criteria. Intraclass correlation coefficients for the different component of MS were: 0.93 (IC 95%:0.91- 0.95 for BMI; 0.96 (IC 95%: 0.93-0.98 for waist circumference; 0.75 (IC 95%: 0.66-0.82 for fasting glucose; 0.50 (IC 95%:0.35-0.639 for HDL cholesterol; 0.78 (IC 95%: 0.70-0.84 for triglycerides; 0.49 (IC 95%:0.34-0.61 for systolic blood pressure and 0.55 (IC 95%: 0.41-0.65 for diastolic blood pressure. Conclusions Self-reported MS based on self reported components of the SM in a Spanish cohort of university graduates was sufficiently valid as to be used in epidemiological studies.

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...

Personal health records in the preclinical medical curriculum: modeling student responses in a simple educational environment utilizing Google Health

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Karamanlis Dimokratis A

2012-09-01

Full Text Available Abstract Background Various problems concerning the introduction of personal health records in everyday healthcare practice are reported to be associated with physicians’ unfamiliarity with systematic means of electronically collecting health information about their patients (e.g. electronic health records - EHRs. Such barriers may further prevent the role physicians have in their patient encounters and the influence they can have in accelerating and diffusing personal health records (PHRs to the patient community. One way to address these problems is through medical education on PHRs in the context of EHR activities within the undergraduate medical curriculum and the medical informatics courses in specific. In this paper, the development of an educational PHR activity based on Google Health is reported. Moreover, student responses on PHR’s use and utility are collected and presented. The collected responses are then modelled to relate the satisfaction level of students in such a setting to the estimation about their attitude towards PHRs in the future. Methods The study was conducted by designing an educational scenario about PHRs, which consisted of student instruction on Google Health as a model PHR and followed the guidelines of a protocol that was constructed for this purpose. This scenario was applied to a sample of 338 first-year undergraduate medical students. A questionnaire was distributed to each one of them in order to obtain Likert-like scale data on the sample’s response with respect to the PHR that was used; the data were then further analysed descriptively and in terms of a regression analysis to model hypothesised correlations. Results Students displayed, in general, satisfaction about the core PHR functions they used and they were optimistic about using them in the future, as they evaluated quite high up the level of their utility. The aspect they valued most in the PHR was its main role as a record-keeping tool, while

A search algorithm for identifying likely users and non-users of marijuana from the free text of the electronic medical record.

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Salomeh Keyhani

Full Text Available The harmful effects of marijuana on health and in particular cardiovascular health are understudied. To develop such knowledge, an efficient method of developing an informative cohort of marijuana users and non-users is needed.We identified patients with a diagnosis of coronary artery disease using ICD-9 codes who were seen in the San Francisco VA in 2015. We imported these patients' medical record notes into an informatics platform that facilitated text searches. We categorized patients into those with evidence of marijuana use in the past 12 months and patients with no such evidence, using the following text strings: "marijuana", "mjx", and "cannabis". We randomly selected 51 users and 51 non-users based on this preliminary classification, and sent a recruitment letter to 97 of these patients who had contact information available. Patients were interviewed on marijuana use and domains related to cardiovascular health. Data on marijuana use collected from the medical record was compared to data collected as part of the interview.The interview completion rate was 71%. Among the 35 patients identified by text strings as having used marijuana in the previous year, 15 had used marijuana in the past 30 days (positive predictive value = 42.9%. The probability of use in the past month increased from 8.8% to 42.9% in people who have these keywords in their medical record compared to those who did not have these terms in their medical record.Methods that combine text search strategies for participant recruitment with health interviews provide an efficient approach to developing prospective cohorts that can be used to study the health effects of marijuana.

Scalable decision support at the point of care: a substitutable electronic health record app for monitoring medication adherence.

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Bosl, William; Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

2013-07-22

Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as "iPhone like platforms" by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients' prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction

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

Science.gov (United States)

Baird, Shawn; Boak, George

2016-05-03

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

Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education

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Hersh WR

2014-07-01

Full Text Available William R Hersh,1 Paul N Gorman,1 Frances E Biagioli,2 Vishnu Mohan,1 Jeffrey A Gold,3 George C Mejicano4 1Department of Medical Informatics and Clinical Epidemiology, 2Department of Family Medicine, 3Department of Medicine, 4School of Medicine, Oregon Health & Science University, Portland, OR, USA Abstract: Physicians in the 21st century will increasingly interact in diverse ways with information systems, requiring competence in many aspects of clinical informatics. In recent years, many medical school curricula have added content in information retrieval (search and basic use of the electronic health record. However, this omits the growing number of other ways that physicians are interacting with information that includes activities such as clinical decision support, quality measurement and improvement, personal health records, telemedicine, and personalized medicine. We describe a process whereby six faculty members representing different perspectives came together to define competencies in clinical informatics for a curriculum transformation process occurring at Oregon Health & Science University. From the broad competencies, we also developed specific learning objectives and milestones, an implementation schedule, and mapping to general competency domains. We present our work to encourage debate and refinement as well as facilitate evaluation in this area. Keywords: curriculum transformation, clinical decision support, patient safety, health care quality, patient engagement

Evaluation of Data Recording at Teaching Hospitals

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Hasan Karbasi

2009-02-01

Full Text Available Background and purpose: Medical records of patients have an undeniable role on education, research and evaluation of health care delivery, and also could be used as reliable documents of past in casesof patients’ legal complains. This study was done to evaluate medical data recording at teaching hospital of Birjand University of Medical Sciences in 2004.Methods: In this descriptive-analytic study, 527 patients’ records of patients who had been discharged from general wards of the hospitals after 24 hours of hospitalization were randomly selected. 18 standard titles of records include in each patient’s record were evaluated using checklists. Data were analyzed using frequency distribution tables, independent t-test and Chi-square test.Results: Items on records’ titles were completed in a range of 0-100%. Titles of neonates and nursing care with 96% completeness were the most completed ones~ Titles of recovery, pre-delivery care, medical history, summary, and progress notes with 50% to 74% completeness were categorized as moderately completed titles; and titles of vital signs, pre-operation care and operation report were weak. Records of the infectious diseases ward were the most completed records (68% and the least completed were from ophthmology ward (35.8%. There were significant differences between the hospitals and between different wards.Conclusion: Results of this study show the need for further education on record writing, taking medical history, and order writing and more importantly the need for a system of continuous monitoringof the records.Keywords: MEDICAL RECORD, TEACHING HOSPITAL, EVALUATION