Pedro Luiz Cortês
Full Text Available The importance of patient records, also known as medical records, is related to different needs and objectives, as they constitute permanent documents on the health of patients. With the advancement of information technologies and systems, patient records can be stored in databases, resulting in a positive impact on patient care. Based on these considerations, a research question that arises is “what are the benefits and problems that can be seen with the use of electronic versions of medical records?” This question leads to the formulation of the following hypothesis: although problems can be identified during the process of using electronic record systems, the benefits outweigh the difficulties, thereby justifying their use. To respond to the question and test the presented hypothesis, a research study was developed with users of the same electronic record system, consisting of doctors, nurses, and administrative personnel in three hospitals located in the city of São Paulo, Brazil. The results show that, despite some problems in their usage, the benefits of electronic patient records outweigh possible disadvantages.
van 't Noordende, G.
In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a national infrastructure for exchanging medical patient records among authorized parties (particularly, physicians), the EPD has to address a number of requirements, ranging from
van 't Noordende, G.
In this article, we analyze the security architecture of the Dutch Electronic Patient Dossier (EPD) system. Intended as a mandatory infrastructure for exchanging medical records of most if not all patients in the Netherlands among authorized parties (particularly, physicians), the EPD has to address
Uto, Yumiko; Iwaanakuchi, Takashi; Muranaga, Fuminori; Kumamoto, Ichiro
In Japan, POS (problem oriented system) is recommended in the clinical guideline. Therefore, the records are mainly made by SOAP. We developed a system mainly with a function which enabled our staff members of all kinds of professions including doctors to enter the patients' clinical information as an identical record, regardless if they were outpatients or inpatients, and to observe the contents chronologically. This electric patient record system is called "e-kanja recording system". On this system, all staff members in the medical team can now share the same information. Moreover, the contents can be reviewed by colleagues; the quality of records has been improved as it is evaluated by the others.
Christensen, Tom; Faxvaag, Arild; Loerum, Hallvard; Grimsmo, Anders
To evaluate GPs use of three major electronic patient record systems with emphasis on the ability of the systems to support important clinical tasks and to compare the findings with results from a study of the three major hospital-wide systems. A national, cross-sectional questionnaire survey was conducted in Norwegian primary care. 247 (73%) of 338 GPs responded. Proportions of the respondents who reported to use the EPR system to conduct 23 central clinical tasks, differences in the proportions of users of different EPR systems and user satisfaction and perceived usefulness of the EPR system were measured. The GPs reported extensive use of their EPR systems to support clinical tasks. There were no significant differences in functionality between the systems, but there were differences in reported software and hardware dysfunction and user satisfaction. The respondents reported high scores in computer literacy and there was no correlation between computer usage and respondent age or gender. A comparison with hospital physicians' use of three hospital-wide EPR systems revealed that GPs had higher usage than the hospital-based MDs. Primary care EPR systems support clinical tasks far better than hospital systems with better overall user satisfaction and reported impact on the overall quality of the work. EPR systems in Norwegian primary care that have been developed in accordance with the principles of user-centered design have achieved widespread adoption and highly integrated use. The quality and efficiency of the clinical work has increased in contrast to the situation of their hospital colleagues, who report more modest use and benefits of EPR systems.
Sierdziński, Janusz; Karpiński, Grzegorz
In modern medicine the well structured patient data set, fast access to it and reporting capability become an important question. With the dynamic development of information technology (IT) such question is solved via building electronic patient record (EPR) archives. We then obtain fast access to patient data, diagnostic and treatment protocols etc. It results in more efficient, better and cheaper treatment. The aim of the work was to design a uniform Electronic Patient Record, implemented in cardio.net system for telecardiology allowing the co-operation among regional hospitals and reference centers. It includes questionnaires for demographic data and questionnaires supporting doctor's work (initial diagnosis, final diagnosis, history and physical, ECG at the discharge, applied treatment, additional tests, drugs, daily and periodical reports). The browser is implemented in EPR archive to facilitate data retrieval. Several tools for creating EPR and EPR archive were used such as: XML, PHP, Java Script and MySQL. The separate question is the security of data on WWW server. The security is ensured via Security Socket Layer (SSL) protocols and other tools. EPR in Cardio.net system is a module enabling the co-work of many physicians and the communication among different medical centers.
automated medical records. The report discusses the potential benefits that automation could make to the quality of patient care and the factors that impede...information systems, but no organization has fully automated one of the most critical types of information, patient medical records. The patient medical record...its review of automated medical records. GAO’s objectives in this study were to identify the (1) benefits of automating patient records and (2) factors
Pediatric ICU with severe sepsis/shock...traumatic brain injury and pulmonary embolus and in both adult and pediatric patients. CDS can be a...record, pediatric critical care, neonatal intensive care, severe sepsis, septic shock 16. SECURITY CLASSIFICATION
Full Text Available A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.
Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracti...... Classification of Disease ontology and is therefore in principle language independent. As a use case we show how records from a Danish psychiatric hospital lead to the identification of disease correlations, which subsequently are mapped to systems biology frameworks....
MD. NURUL HUDA
Full Text Available Patient-controlled personal health record systems can help make health care safer, cheaper, and more convenient by facilitating patients to 1 grant any care provider access to their complete personal health records anytime from anywhere, 2 avoid repeated tests and 3 control their privacy transparently. In this paper, we present the architecture of our Privacy-aware Patient-controlled Personal Health Record (P3HR system through which a patient can view her integrated health history, and share her health information transparently with others (e.g., healthcare providers. Access to the health information of a particular patient is completely controlled by that patient. We also carry out intuitive security and privacy analysis of the P3HR system architecture considering different types of security attacks. Finally, we describe a prototype implementation of the P3HR system that we developed reflecting the special view of Japanese society. The most important advantage of P3HR system over other existing systems is that most likely P3HR system provides complete privacy protection without losing data accuracy. Unlike traditional partially anonymous health records (e.g., using k-anonymity or l-diversity, the health records in P3HR are closer to complete anonymity, and yet preserve data accuracy. Our approach makes it very unlikely that patients could be identified by an attacker from their anonymous health records in the P3HR system.
Hohnloser, J H; Pürner, F
Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, ). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).
Hsiao, Rong-Shue; Mi, Zhenqiang; Yang, Bo-Ru; Kau, Lih-Jen; Bitew, Mekuanint Agegnehu; Li, Tzu-Yu
This paper proposes body posture recognition and turning recording system for assisting the care of bed bound patients in nursing homes. The system continuously detects the patient's body posture and records the length of time for each body posture. If the patient remains in the same body posture long enough to develop pressure ulcers, the system notifies caregivers to change the patient's body posture. The objective of recording is to provide the log of body turning for querying of patients' family members. In order to accurately detect patient's body posture, we developed a novel pressure sensing pad which contains force sensing resistor sensors. Based on the proposed pressure sensing pad, we developed a bed posture recognition module which includes a bed posture recognition algorithm. The algorithm is based on fuzzy theory. The body posture recognition algorithm can detect the patient's bed posture whether it is right lateral decubitus, left lateral decubitus, or supine. The detected information of patient's body posture can be then transmitted to the server of healthcare center by the communication module to perform the functions of recording and notification. Experimental results showed that the average posture recognition accuracy for our proposed module is 92%.
Zhang, Jianguo; Chen, Xiaomeng; Zhuang, Jun; Jiang, Jianrong; Zhang, Xiaoyan; Wu, Dongqing; Huang, H. K.
In this paper, we presented a new security approach to provide security measures and features in both healthcare information systems (PACS, RIS/HIS), and electronic patient record (EPR). We introduced two security components, certificate authoring (CA) system and patient record digital signature management (DSPR) system, as well as electronic envelope technology, into the current hospital healthcare information infrastructure to provide security measures and functions such as confidential or privacy, authenticity, integrity, reliability, non-repudiation, and authentication for in-house healthcare information systems daily operating, and EPR exchanging among the hospitals or healthcare administration levels, and the DSPR component manages the all the digital signatures of patient medical records signed through using an-symmetry key encryption technologies. The electronic envelopes used for EPR exchanging are created based on the information of signers, digital signatures, and identifications of patient records stored in CAS and DSMS, as well as the destinations and the remote users. The CAS and DSMS were developed and integrated into a RIS-integrated PACS, and the integration of these new security components is seamless and painless. The electronic envelopes designed for EPR were used successfully in multimedia data transmission.
Calvo-Alén, J; Alarcón, G S; Campbell, R; Fernández, M; Reveille, J D; Cooper, G S
To determine to what extent the diagnosis of systemic lupus erythematosus (SLE) in deceased lupus patients is under-reported in death certificates, and the patient characteristics associated with such an occurrence. The death certificates of 76 of the 81 deceased SLE patients from two US lupus cohorts (LUMINA for Lupus in Minorities: Nature vs Nurture and CLU for Carolina Lupus Study), including 570 and 265 patients, respectively, were obtained from the Offices of Vital Statistics of the states where the patients died (Alabama, Georgia, North Carolina, South Carolina, Tennessee and Texas). Both cohorts included patients with SLE as per the American College of Rheumatology criteria, aged > or =16 yr, and disease duration at enrolment of < or =5 yr. The median duration of follow-up in each cohort at the time of these analyses ranged from 38.1 to 53.0 months. Standard univariable analyses were performed comparing patients with SLE recorded anywhere in the death certificate and those without it. A multivariable logistic regression model was performed to identify the variables independently associated with not recording SLE in death certificates. In 30 (40%) death certificates, SLE was not recorded anywhere in the death certificate. In univariable analyses, older age was associated with lack of recording of SLE in death certificates [mean age (standard deviation) 50.9 (15.6) years and 39.1 (18.6) yr among those for whom SLE was omitted and included on the death certificates, respectively, P = 0.005]. Patients without health insurance, those dying of a cardiovascular event and those of Caucasian ethnicity were also more likely to be in the non-recorded group. In the multivariable analysis, variables independently associated with not recording SLE as cause of death were older age [odds ratio = (95% confidence interval) 1.043 (1.005-1.083 per yr increase); P = 0.023] and lack of health insurance [4.649 (1.152-18.768); P = 0.031]. A high proportion of SLE diagnoses are not
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
Schreiweis, Björn; Trinczek, Benjamin; Köpcke, Felix; Leusch, Thomas; Majeed, Raphael W; Wenk, Joachim; Bergh, Björn; Ohmann, Christian; Röhrig, Rainer; Dugas, Martin; Prokosch, Hans-Ulrich
Reusing data from electronic health records for clinical and translational research and especially for patient recruitment has been tackled in a broader manner since about a decade. Most projects found in the literature however focus on standalone systems and proprietary implementations at one particular institution often for only one singular trial and no generic evaluation of EHR systems for their applicability to support the patient recruitment process does yet exist. Thus we sought to assess whether the current generation of EHR systems in Germany provides modules/tools, which can readily be applied for IT-supported patient recruitment scenarios. We first analysed the EHR portfolio implemented at German University Hospitals and then selected 5 sites with five different EHR implementations covering all major commercial systems applied in German University Hospitals. Further, major functionalities required for patient recruitment support have been defined and the five sample EHRs and their standard tools have been compared to the major functionalities. In our analysis of the site's hospital information system environments (with four commercial EHR systems and one self-developed system) we found that - even though no dedicated module for patient recruitment has been provided - most EHR products comprise generic tools such as workflow engines, querying capabilities, report generators and direct SQL-based database access which can be applied as query modules, screening lists and notification components for patient recruitment support. A major limitation of all current EHR products however is that they provide no dedicated data structures and functionalities for implementing and maintaining a local trial registry. At the five sites with standard EHR tools the typical functionalities of the patient recruitment process could be mostly implemented. However, no EHR component is yet directly dedicated to support research requirements such as patient recruitment. We
Kalinski, Thomas; Hofmann, Harald; Franke, Dagmar-Sybilla; Roessner, Albert
Picture archiving and communication systems have been widely used in radiology thus far. Owing to the progress made in digital photo technology, their use in medicine opens up further opportunities. In the field of pathology, digital imaging offers new possiblities for the documentation of macroscopic and microscopic findings. Digital imaging has the advantage that the data is permanently and readily available, independent of conventional archives. In the past, PACS was a separate entity. Meanwhile, however, PACS has been integrated in DIS, the department information system, which was also run separately in former times. The combination of these two systems makes the administration of patient data, findings and images easier. Moreover, thanks to the introduction of special communication standards, a data exchange between different department information systems and hospital information systems (HIS) is possible. This provides the basis for a communication platform in medicine, constituting an electronic patient record (EPR) that permits an interdisciplinary treatment of patients by providing data of findings and images from clinics treating the same patient. As the pathologic diagnosis represents a central and often therapy-determining component, it is of utmost importance to add pathologic diagnoses to the EPR. Furthermore, the pathologist's work is considerably facilitated when he is able to retrieve additional data from the patient file. In this article, we describe our experience gained with the combined PACS and DIS systems recently installed at the Department of Pathology, University of Magdeburg. Moreover, we evaluate the current situation and future prospects for PACS in pathology.
Cheong, P Y; Goh, L G; Ong, R; Wong, P K
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.
Barr, Paul J; Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn
Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth's Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a
Massaut, Jacques; Reper, Pascal
In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.
Anand, Vijay; Hyun, Christian; Khan, Qasim M; Hall, Curtis; Hessefort, Norbert; Sonnenberg, Amnon; Fimmel, Claus J
The aim of this study was to noninvasively assess the severity of chronic hepatitis C virus (HCV) in large patient populations. It would be helpful if fibrosis scores could be calculated solely on the basis of data contained in the patients' electronic medical records (EMR). We performed a pilot study to identify all HCV-infected patients in a large health care system, and predict their fibrosis stage on the basis of demographic and laboratory data using common data from their EMR. HCV-infected patients were identified using the EMR. The liver biopsies of 191 HCV patients were graded using the Ishak and Metavir scoring systems. Demographic and laboratory data were extracted from the EMR and used to calculate the aminotransferase to platelet ratio index, Fib-4, Fibrosis Index, Forns, Göteborg University Cirrhosis Index, Lok Index, and Vira-HepC. In total, 869 HCV-infected patients were identified from a population of over 1 million. In the subgroup of patients with liver biopsies, all 7 algorithms were significantly correlated with the fibrosis stage. The degree of correlation was moderate, with correlation coefficients ranging from 0.22 to 0.60. For the detection of advanced fibrosis (Metavir 3 or 4), the areas under the receiver operating characteristic curve ranged from 0.71 to 0.84, with no significant differences between the individual scores. Sensitivities, specificities, and positive and negative predictive values were within the previously reported range. All scores tended to perform better for higher fibrosis stages. Our study demonstrates that HCV-infected patients can be identified and their fibrosis staged using commonly available EMR-based algorithms.
Bouayad, Lina; Ialynytchev, Anna; Padmanabhan, Balaji
A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice. We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content. We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation. Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR
Wiggley, Shirley L.
Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…
Murakami, Alexandre; Gutierrez, Marco A.; Lage, Silvia G.; Rebelo, Marina S.; Granja, Luiz A. R.; Ramires, Jose A. F.
The control of blood sugar level (BSL) at near-normal levels has been documented to reduce both acute and chronic complications of diabetes mellitus. Recent studies suggested, the reduction of mortality in a surgical intensive care unit (ICU), when the BSL are maintained at normal levels. Despite of the benefits appointed by these and others clinical studies, the strict BSL control in critically ill patients suffers from some difficulties: a) medical staff need to measure and control the patient"s BSL using blood sample at least every hour. This is a complex and time consuming task; b) the inaccuracy of standard capillary glucose monitoring (fingerstick) in hypotensive patients and, if frequently used to sample arterial or venous blood, may lead to excess phlebotomy; c) there is no validated procedure for continuously monitoring of BSL levels. This study used the MiniMed CGMS in ill patients at ICU to send, in real-time, BSL values to a Web-Based Electronic Patient Record. The BSL values are parsed and delivered through a wireless network as an HL7 message. The HL7 messages with BSL values are collected, stored into the Electronic Patient Record and presented into a bed-side monitor at the ICU together with other relevant patient information.
Chandra, A.K.; Deshpande, S.V.; Mayya, A.; Vaidya, U.W.; Premraj, M.K.; Patil, N.B.
A computerized system for disturbance monitoring, recording and display has been developed for use in nuclear power plants and is versatile enough to be used where ever a large number of parameters need to be recorded, e.g. conventional power plants, chemical industry etc. The Disturbance Recording System (DRS) has been designed to continuously monitor a process plant and record crucial parameters. The DRS provides a centralized facility to monitor and continuously record 64 process parameters scanned every 1 sec for 5 days. The system also provides facility for storage of 64 parameters scanned every 200 msec during 2 minutes prior to and 3 minutes after a disturbance. In addition the system can initiate, on demand, the recording of 8 parameters at a fast rate of every 5 msec for a period of 5 sec. and thus act as a visicorder. All this data is recorded in non-volatile memory and can be displayed, printed/plotted and used for subsequent analysis. Since data can be stored densely on floppy disks, the volume of space required for archival storage is also low. As a disturbance recorder, the DRS allows the operator to view the state of the plant prior to occurrence of the disturbance and helps in identifying the root cause. (author). 10 refs., 7 figs
Chandra, A.K.; Deshpande, S.V.; Iyer, A.; Vaidya, U.W.
A large number of critical process parameters in nuclear power plants have hitherto been monitored using electromechanical chart recorders. The reducing costs of electronics systems have led to a trend towards modernizing power plant control rooms by computerizing all the panel instrumentation. As a first step, it has been decided to develop a digital recording system to record the values of 48 process parameters. The system as developed and described in this report is more than a replacement for recorders; it offers substantial advantages in terms of lower overall system cost, excellent time resolution, accurate data and absolute synchronization for correlated signals. The system provides high speed recording of 48 process parameters, maintains historical records and permits retrieval and display of archival information on a colour monitor, a plotter and a printer. It is implemented using a front end data acquisition unit connected on a serial link to a PC-XT computer with 20 MB Winchester. The system offers an extremely user friendly man machine interaction, based on a hierarchical paged menu driven scheme. Softwre development for this system has been carried out using the C language. (author). 9 figs
The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…
Mohammad Reza Tajvidi
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...
Link, M.; Martinek, J.
For nuclear power plants extensive proof of quality is required which has to be documented reliably by quality records. With respect to the paper volume it is the most comprehensive 'curriculum vitae' of the technique. Traditional methods of information and recording are unsatisfactory for meeting regulatory requirements for maintaining the QA-aspects of status reporting, completeness, traceability and retrieval. Therefore KWU has established a record (documentation) subsystem within the overall component qualification system. Examples of the general documentation requirements, the procedure and handling in accordance with this subsystem for mechanical equipment are to be described examplarily. Topics are: - National and international requirements - Definition of QA records - Modular and product orientated KWU-record subsystem - Criteria for developing records - Record control, distribution, collection, storage - New documentation techniques (microfilm, data processing) - Education and training of personnel. (orig./RW)
Hanauer, David; Aberdeen, John; Bayer, Samuel; Wellner, Benjamin; Clark, Cheryl; Zheng, Kai; Hirschman, Lynette
We describe an experiment to build a de-identification system for clinical records using the open source MITRE Identification Scrubber Toolkit (MIST). We quantify the human annotation effort needed to produce a system that de-identifies at high accuracy. Using two types of clinical records (history and physical notes, and social work notes), we iteratively built statistical de-identification models by annotating 10 notes, training a model, applying the model to another 10 notes, correcting the model's output, and training from the resulting larger set of annotated notes. This was repeated for 20 rounds of 10 notes each, and then an additional 6 rounds of 20 notes each, and a final round of 40 notes. At each stage, we measured precision, recall, and F-score, and compared these to the amount of annotation time needed to complete the round. After the initial 10-note round (33min of annotation time) we achieved an F-score of 0.89. After just over 8h of annotation time (round 21) we achieved an F-score of 0.95. Number of annotation actions needed, as well as time needed, decreased in later rounds as model performance improved. Accuracy on history and physical notes exceeded that of social work notes, suggesting that the wider variety and contexts for protected health information (PHI) in social work notes is more difficult to model. It is possible, with modest effort, to build a functioning de-identification system de novo using the MIST framework. The resulting system achieved performance comparable to other high-performing de-identification systems. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Kasthurirathne, Suranga N; Mamlin, Burke; Grieve, Grahame; Biondich, Paul
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.
Heinrichs, W; Mönk, S; Eberle, B
The introduction of electronic anaesthesia documentation systems was attempted as early as in 1979, although their efficient application has become reality only in the past few years. The advantages of the electronic protocol are apparent: Continuous high quality documentation, comparability of data due to the availability of a data bank, reduction in the workload of the anaesthetist and availability of additional data. Disadvantages of the electronic protocol have also been discussed in the literature. By going through the process of entering data on the course of the anaesthetic procedure on the protocol sheet, the information is mentally absorbed and evaluated by the anaesthetist. This information may, however, be lost when the data are recorded fully automatically-without active involvement on the part of the anaesthetist. Recent publications state that by using intelligent alarms and/or integrated displays manual record keeping is no longer necessary for anaesthesia vigilance. The technical design of automated anaesthesia records depends on an integration of network technology into the hospital. It will be appropriate to connect the systems to the internet, but safety requirements have to be followed strictly. Concerning the database, client server architecture as well as language standards like SQL should be used. Object oriented databases will be available in the near future. Another future goal of automated anaesthesia record systems will be using knowledge based technologies within these systems. Drug interactions, disease related anaesthetic techniques and other information sources can be integrated. At this time, almost none of the commercially available systems has matured to a point where their purchase can be recommended without reservation. There is still a lack of standards for the subsequent exchange of data and a solution to a number of ergonomic problems still remains to be found. Nevertheless, electronic anaesthesia protocols will be required in
Choubey, Mona; Mishra, Hrishikesh; Soni, Khushboo; Patra, Pradeep Kumar
Sickle cell disease (SCD) is prevalent in central India including Chhattisgarh. Screening for SCD is being carried out by Government of Chhattisgarh. Electronic Medical Record (EMR) system was developed and implemented in two phases. Aim was to use informatics techniques and indigenously develop EMR system to improve the care of SCD patients in Chhattisgarh. EMR systems had to be developed to store and manage: i) huge data generated through state wide screening for SCD; ii) clinical data for SCD patients attending the outpatient department (OPD) of institute. 'State Wide Screening Data Interface' (SWSDI) was designed and implemented for storing and managing data generated through screening program. Further, 'Sickle Cell Patients Temporal Data Management System' (SCPTDMS) was developed and implemented for storing, managing and analysing sickle cell disease patients' data at OPD. Both systems were developed using VB.Net and MS SQL Server 2012. Till April 2015, SWSDI has data of 1294558 persons, out of which 121819 and 4087 persons are carriers and patients of sickle cell disease respectively. Similarly till June 2015, SCPTDMS has data of 3760 persons, of which 923 are sickle cell disease patients (SS) and 1355 are sickle cell carriers (AS). Both systems are proving to be useful in efficient storage, management and analysis of data for clinical and research purposes. The systems are an example of beneficial usage of medical informatics solutions for managing large data at community level.
Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M
Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient
This Safety Guide was prepared as part of the Agency's programme, referred to as the NUSS programme, for establishing Codes of Practice and Safety Guides relating to nuclear power plants. It supplements the IAEA Code of Practice on Quality Assurance for Safety in Nuclear Power Plants (IAEA Safety Series No.50-C-QA), which requires that for each nuclear power plant a system for the generation, identification, collection, indexing, filing, storing, maintenance and disposition of quality assurance records shall be established and executed in accordance with written procedures and instructions. The purpose of this Safety Guide is to provide assistance in the establishment and operation of such a system. An orderly established and maintained records system is considered to be part of the means of providing a basis for an appropriate level of confidence that the activities which affect the quality of a nuclear power plant have been performed in accordance with the specific requirements and that the required quality has been achieved and is maintained
Dayhoff, R. E.; Kuzmak, P. M.; Kirin, G.; Frank, S.
Seamless integration of all types of patient data is a critical feature for clinical workstation software. The Dept. of Veterans Affairs has developed a multimedia online patient record that includes traditional medical chart information as well as a wide variety of medical images from specialties such as cardiology, pulmonary and gastrointestinal medicine, pathology, radiology, hematology, and nuclear medicine. This online patient record can present data in ways not possible with a paper chart or other physical media. Obtaining a critical mass of information online is essential to achieve the maximum benefits from an integrated patient record system. Images Figure 1 Figure 2 PMID:10566357
Rosenblatt, Lisa; Broder, Michael S; Bentley, Tanya G K; Chang, Eunice; Reddy, Sheila R; Papoyan, Elya; Myers, Joel
Efavirenz (EFV) is a non-nucleoside reverse transcriptase inhibitor indicated for treatment of HIV-1 infection. Despite concern over EFV tolerability in clinical trials and practice, particularly related to central nervous system (CNS) adverse events, some observational studies have shown high rates of EFV continuation at one year and low rates of CNS-related EFV substitution. The objective of this study was to further examine the real-world rate of CNS-related EFV discontinuation in antiretroviral therapy naïve HIV-1 patients. This retrospective cohort study used a nationally representative electronic medical records database to identify HIV-1 patients ≥12 years old, treated with a 1st-line EFV-based regimen (single or combination antiretroviral tablet) from 1 January 2009 to 30 June 2013. Patients without prior record of EFV use during 6-month baseline (i.e., antiretroviral therapy naïve) were followed 12 months post-medication initiation. CNS-related EFV discontinuation was defined as evidence of a switch to a replacement antiretroviral coupled with record of a CNS symptom within 30 days prior, absent lab evidence of virologic failure. We identified 1742 1st-line EFV patients. Mean age was 48 years, 22.7% were female, and 8.1% had a prior report of CNS symptoms. The first year, overall discontinuation rate among new users of EFV was 16.2%. Ten percent of patients (n = 174) reported a CNS symptom and 1.1% (n = 19) discontinued EFV due to CNS symptoms: insomnia (n = 12), headache (n = 5), impaired concentration (n = 1), and somnolence (n = 1). The frequency of CNS symptoms was similar for patients who discontinued EFV compared to those who did not (10.3 vs. 9.9%; P = .86). Our study found that EFV discontinuation due to CNS symptoms was low, consistent with prior reports.
Adelhard, K; Eckel, R; Hölzel, D; Tretter, W
Computerized medical record systems (CPRS) should present user and problem oriented views of the patient file. Problem lists, clinical course, medication profiles and results of examinations have to be recorded in a computerized patient record. Patient review screens should give a synopsis of the patient data to inform whenever the patient record is opened. Several different types of data have to be stored in a patient record. Qualitative and quantitative measurements, narratives and images are such examples. Therefore, a CPR must also be able to handle these different data types. New methods and concepts appear frequently in medicine. Thus a CPRS must be flexible enough to cope with coming demands. We developed a prototype of a computer based patient record with a graphical user interface on a SUN workstation. The basis of the system are a dynamic data dictionary, an interpreter language and a large set of basic functions. This approach gives optimal flexibility to the system. A lot of different data types are already supported. Extensions are easily possible. There is also almost no limit concerning the number of medical concepts that can be handled by our prototype. Several applications were built on this platform. Some of them are presented to exemplify the patient and problem oriented handling of the CPR.
Kitamura, Takayuki; Hoshimoto, Hiroyuki; Yamada, Yoshitsugu
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.
... 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...
was also thought to motivate the patients to act on the advice given, and the records also served as a reminder to take their ... to use it and to standardise the information that is recorded; and health planners should be motivated to implement .... Table I: Combined list of themes identified and quotations supporting them.
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.
V. P. Martsenyuk
Full Text Available The article analyzes the procedure of implementation of information system of recording for consultation patients to specialists - health workers. It was shown the feasibility of an infor mation system selfrecor ding patients on admission. Are limited prospects improve quality of care through the implementation of the rights of patients to the same account.
Full Text Available regarding continuity of care, typical healthcare protocols, a study of public healthcare district hospital information systems and both public and private primary healthcare information systems....
Eom, Jieun; Lee, Dong Hoon; Lee, Kwangsu
In recent years, many countries have been trying to integrate electronic health data managed by each hospital to offer more efficient healthcare services. Since health data contain sensitive information of patients, there have been much research that present privacy preserving mechanisms. However, existing studies either require a patient to perform various steps to secure the data or restrict the patient to exerting control over the data. In this paper, we propose patient-controlled attribute-based encryption, which enables a patient (a data owner) to control access to the health data and reduces the operational burden for the patient, simultaneously. With our method, the patient has powerful control capability of his/her own health data in that he/she has the final say on the access with time limitation. In addition, our scheme provides emergency medical services which allow the emergency staffs to access the health data without the patient's permission only in the case of emergencies. We prove that our scheme is secure under cryptographic assumptions and analyze its efficiency from the patient's perspective.
McInnes D Keith
Full Text Available Abstract Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising
Kahouei, Mehdi; Zadeh, Jamileh Mahdi; Roghani, Panoe Seyed
In a developing country like Iran, wasting economic resources has a number of negative consequences. Therefore, it is crucial that problems of introducing new electronic systems be identified and addressed early to avoid failure of the programs. The purpose of this study was to evaluate head nurses' and supervisors' perceptions about the efficiency of the electronic patient record (EPR) system and its impact on nursing management tasks in order to provide useful recommendations. This descriptive study was performed in teaching hospitals affiliated to Semnan University of Medical Sciences, Iran. An anonymous self-administered questionnaire was developed. Head nurses and supervisors were included in this study. It was found that the EPR system was immature and was not proportionate to the operational level. Moreover, few head nurses and supervisors agreed on the benefits of the EPR system on the performance of their duties such as planning, organizing, budgeting, and coordinating. It is concluded that in addition to the technical improvements, the social and cultural factors should be considered to improve the acceptability of electronic systems through social marketing in the different aspects of nursing management. It is essential that health information technology managers emphasize on training head nurses and supervisors to design technology corresponding to their needs rather than to accept poorly designed technology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Marceglia, S; Fontelo, P; Rossi, E; Ackerman, M J
Mobile health Applications (mHealth Apps) are opening the way to patients' responsible and active involvement with their own healthcare management. However, apart from Apps allowing patient's access to their electronic health records (EHRs), mHealth Apps are currently developed as dedicated "island systems". Although much work has been done on patient's access to EHRs, transfer of information from mHealth Apps to EHR systems is still low. This study proposes a standards-based architecture that can be adopted by mHealth Apps to exchange information with EHRs to support better quality of care. Following the definition of requirements for the EHR/mHealth App information exchange recently proposed, and after reviewing current standards, we designed the architecture for EHR/mHealth App integration. Then, as a case study, we modeled a system based on the proposed architecture aimed to support home monitoring for congestive heart failure patients. We simulated such process using, on the EHR side, OpenMRS, an open source longitudinal EHR and, on the mHealth App side, the iOS platform. The integration architecture was based on the bi-directional exchange of standard documents (clinical document architecture rel2 - CDA2). In the process, the clinician "prescribes" the home monitoring procedures by creating a CDA2 prescription in the EHR that is sent, encrypted and de-identified, to the mHealth App to create the monitoring calendar. At the scheduled time, the App alerts the patient to start the monitoring. After the measurements are done, the App generates a structured CDA2-compliant monitoring report and sends it to the EHR, thus avoiding local storage. The proposed architecture, even if validated only in a simulation environment, represents a step forward in the integration of personal mHealth Apps into the larger health-IT ecosystem, allowing the bi-directional data exchange between patients and healthcare professionals, supporting the patient's engagement in self
Lyon, M.; Martin, J.B.
Occupational protection records have traditionally been generated by field and laboratory personnel, assembled into files in the safety office, and eventually stored in a warehouse or other facility. Until recently, these records have been primarily paper copies, often handwritten. Sometimes, the paper is microfilmed for storage. However, electronic records are beginning to replace these traditional methods. The purpose of this paper is to provide guidance for making the transition to automated record keeping and retrieval using modern computer equipment. This paper describes the types of records most readily converted to electronic record keeping and a methodology for implementing an automated record system. The process of conversion is based on a requirements analysis to assess program needs and a high level of user involvement during the development. The importance of indexing the hard copy records for easy retrieval is also discussed. The concept of linkage between related records and its importance relative to reporting, research, and litigation will be addressed. 2 figs
Guo, Jinqiu; Takada, Akira; Tanaka, Koji; Sato, Junzo; Suzuki, Muneou; Takahashi, Kiwamu; Daimon, Hiroyuki; Suzuki, Toshiaki; Nakashima, Yusei; Araki, Kenji; Yoshihara, Hiroyuki
With the evolving and diverse electronic medical record (EMR) systems, there appears to be an ever greater need to link EMR systems and patient accounting systems with a standardized data exchange format. To this end, the CLinical Accounting InforMation (CLAIM) data exchange standard was developed. CLAIM is subordinate to the Medical Markup Language (MML) standard, which allows the exchange of medical data among different medical institutions. CLAIM uses eXtensible Markup Language (XML) as a meta-language. The current version, 2.1, inherited the basic structure of MML 2.x and contains two modules including information related to registration, appointment, procedure and charging. CLAIM 2.1 was implemented successfully in Japan in 2001. Consequently, it was confirmed that CLAIM could be used as an effective data exchange format between EMR systems and patient accounting systems.
Quinlivan, Julie A; Lyons, Sarah; Petersen, Rodney W
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.
Full Text Available The introduction of a national electronic health record system to the National Health Service (NHS has raised concerns about issues of data accuracy, security and confidentiality. The primary aim of this project was to identify the extent to which primary care patients will allow their local electronic record data to be shared on a national database. The secondary aim was to identify the extent of inaccuracies in the existing primary care records, which will be used to populate the new national Spine. Fifty consecutive attenders to one general practitioner were given a paper printout of their full primary care electronic health record. Participants were asked to highlight information which they would not want to be shared on the national electronic database of records, and information which they considered to be incorrect. There was a 62% response rate (31/50. Five of the 31 patients (16% identified information that they would not want to be shared on the national record system. The items they identified related almost entirely to matters of pregnancy, contraception, sexual health and mental health. Ten respondents (32% identified incorrect information in their records (some of these turned out to be correct on further investigation. The findings in relation to data sharing fit with the commonly held assumption that matters related to sensitive or embarrassing issues, which may affect how the patient will be treated by other individuals or institutions, are most likely to be censored by patients. Previous work on this has tended to ask hypothetical questions concerning data sharing rather than examine a real situation. A larger study of representative samples of patients in both primary and secondary care settings is needed to further investigate issues of data sharing and consent.
Blijleven, Vincent; Koelemeijer, Kitty; Wetzels, Marijntje; Jaspers, Monique
Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow unintendedly imposed by electronic health record systems (EHRs). Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness of care, and efficiency of care. Research into the scope and impact of EHR workarounds on patient care processes is scarce. This paper provides insight into the effects of EHR workarounds on organizational workflows and outcomes of care services by identifying EHR workarounds and determining their rationales, scope, and impact on health care providers' workflows, patient safety, effectiveness of care, and efficiency of care. Knowing the rationale of a workaround provides valuable clues about the source of origin of each workaround and how each workaround could most effectively be resolved. Knowing the scope and impact a workaround has on EHR-related safety, effectiveness, and efficiency provides insight into how to address related concerns. Direct observations and follow-up semistructured interviews with 31 physicians, 13 nurses, and 3 clerks and qualitative bottom-up coding techniques was used to identify, analyze, and classify EHR workarounds. The research was conducted within 3 specialties and settings at a large university hospital. Rationales were associated with work system components (persons, technology and tools, tasks, organization, and physical environment) of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to reveal their source of origin as well as to determine the scope and the impact of each EHR workaround from a structure-process-outcome perspective. A total of 15 rationales for EHR workarounds were identified of which 5 were associated with persons, 4 with technology and tools, 4 with the organization, and 2 with the tasks. Three of these 15 rationales for EHR workarounds have not been identified in prior
Jobanputra, Kiran; Greig, Jane; Shankar, Ganesh; Perakslis, Eric; Kremer, Ronald; Achar, Jay; Gayton, Ivan
By November 2015, the West Africa Ebola epidemic had caused 28598 infections and 11299 deaths in the three countries most affected. The outbreak required rapid innovation and adaptation. Médecins sans Frontières (MSF) scaled up its usual 20-30 bed Ebola management centres (EMCs) to 100-300 beds with over 300 workers in some settings. This brought challenges in patient and clinical data management resulting from the difficulties of working safely with high numbers of Ebola patients. We describe a project MSF established with software developers and the Google Social Impact Team to develop context-adapted tools to address the challenges of recording Ebola clinical information. We share the outcomes and key lessons learned in innovating rapidly under pressure in difficult environmental conditions. Information on adoption, maintenance, and data quality was gathered through review of project documentation, discussions with field staff and key project stakeholders, and analysis of tablet data. In March 2015, a full prototype was deployed in Magburaka EMC, Sierra Leone. Inpatient data were captured on 204 clinical interactions with 34 patients from 5 March until 10 April 2015. Data continued to also be recorded on paper charts, creating theoretically identical record "pairs" on paper and tablet. 83 record pairs for 33 patients with 22 data items (temperature and symptoms) per pair were analysed. The overall Kappa coefficient for agreement between sources was 0.62, but reduced to 0.59 when rare bleeding symptoms were excluded, indicating moderate to good agreement. The time taken to deliver the product was more than that anticipated by MSF (7 months versus 6 weeks). Deployment of the tablet coincided with a dramatic drop in patient numbers and thus had little impact on patient care. We have identified lessons specific to humanitarian-technology collaborative projects and propose a framework for emergency humanitarian innovation. Time and effort is required to bridge
Oluoch, Tom; Katana, Abraham; Ssempijja, Victor; Kwaro, Daniel; Langat, Patrick; Kimanga, Davies; Okeyo, Nicky; Abu-Hanna, Ameen; de Keizer, Nicolette
There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on
Surate Solaligue, David Emanuel; Hederman, Lucy; Martin, Carmel Mary
Timely access to general practitioner (GP) care is a recognized strategy to address avoidable hospitalization. Little is known about patients seeking planned (decided ahead) and unplanned (decided on day) GP visits. The Patient Journey Record System (PaJR) provides a biopsychosocial real-time monitoring and support service to chronically ill and older people over 65 who may be at risk of an avoidable hospital admission. This study aims to describe reported profiles associated with planned and unplanned GP visits during the week in the PaJR database of regular outbound phone calls made by Care Guides to multi-morbid older patients. One hundred fifty consecutive patients with one or more chronic condition (including chronic obstructive pulmonary disease, heart/vascular disease, heart failure and/or diabetes), one or more hospital admission in previous year, and consecutively recruited from hospital discharge, out-of-hour care and GP practices comprised the study sample. Using a semistructured script, Care Guides telephoned the patients approximately every 3 week days, and entered call data into the PaJR database in 2011. The PaJR project identified and prompted unplanned visits according to its algorithms. Logistic regression modelling and descriptive statistics identified significant predictors of planned and unplanned visits and patterns of GP visits on weekdays reported in calls. In 5096 telephone calls, unplanned versus planned GP visits were predicted by change in health state, significant symptom concerns, poor self-rated health, bodily pain and concerns about caregiver or intimates. Calls not reporting visits had significantly fewer of these features. Planned visits were associated with general and medication concerns, reduced social participation and feeling down. Planned visits were highest on Monday and trended downwards to Fridays. Unplanned visits were reported at the same rate each weekday and more frequently when the interval between calls was ≥3 days
Mariani, Peter J
A pilot study was done to assess the feasibility of using a LAN-based voice communication system to convey physician-patient assignment in the emergency department (ED). Via their communicators, physicians were expected to notify registration staff in real-time upon care assumption of each new patient. Over a two month trial, compliance went from poor to dismal, and this method of notification was abandoned.
... practices data, and employee health hazard educational data. Records include the name, Social Security... system of records notice. Note 2: Personal identity, diagnosis, prognosis of any patient maintained in... Records in the System: Storage: Paper records and electronic storage media. Retrievability: By individual...
Naszlady, A; Naszlady, J
A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.
Houben, Steven; Frost, Mads; Bardram, Jakob E
The patient record is one of the central artifacts in medical work that is used to organize, communicate and coordinate important information related to patient care. In many hospitals a double record consisting of an electronic and paper part is maintained. This practice introduces a number of c......PR device decreases configuration work, supports mobility in clinical work and increases awareness on patient data.......The patient record is one of the central artifacts in medical work that is used to organize, communicate and coordinate important information related to patient care. In many hospitals a double record consisting of an electronic and paper part is maintained. This practice introduces a number...... introduce the HyPR Device, a device that merges the paper and electronic patient record into one system. We provide results from a clinical simulation with eight clinicians and discuss the functional, design and infrastructural requirements of such hybrid patient records. Our study suggests that the Hy...
Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.
Recent studies indicate again that there is a deficit in the use of electronic health records (EHR) in German hospitals. Despite good arguments in favour of their use, such as the rapid availability of data, German hospitals shy away from a wider implementation. The reason is the high cost of installing and maintaining the EHRs, for the benefit is difficult to evaluate in monetary terms for the hospital. Even if a benefit can be shown it is not necessarily evident within the hospital, but manifests itself only in the health system outside. Many hospitals only manage to partly implement EHR resulting in increased documentation requirements which reverse their positive effect.In the United States, electronic medical records are also viewed in light of their positive impact on patient safety. In particular, electronic medication systems prove the benefits they can provide in the context of patient safety. As a result, financing systems have been created to promote the digitalisation of hospitals in the United States. This has led to a large increase in the use of IT systems in the United States in recent years. The Universitätsklinikum Eppendorf (UKE) introduced electronic patient records in 2009. The benefits, in particular as regards patient safety, are numerous and there are many examples to illustrate this position. These positive results are intended to demonstrate the important role EHR play in hospitals. A financing system of the ailing IT landscape based on the American model is urgently needed to benefit-especially in terms of patient safety-from electronic medical records in the hospital.
Jensen, Lotte Groth
the possibilities to mark up pages in personal ways and add personal notes to it. On the other hand, the EPR provides quick and easy access to lot of information and once information is entered in the EPR they stay in place. Information in the EPR is often updated due to real time entry, which avoid...... that information has to travel physically between different departments or different hospitals. Another advantage in the creation of clinical overview, when using an EPR, is that the record is never lost. If you have access to a computer, you have access to the record. Besides this, the search function...... at hospitals, these results indicate that you need to think besides the presentation of information. If the physicians are supposed to create an overview, information should be presented in ways that enables them to interpret and make sense of this information. At the same time, to support the creation...
Simon de Lusignan
Full Text Available Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user’s preferences. The use of electronic patient record (EPR systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.
de Lusignan, Simon; Pearce, Christopher; Munro, Neil
Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.
... government and the public. When not considered mandatory, patient identification data shall be eliminated...; System of Records AGENCY: Department of the Air Force, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Department of the Air Force is proposing to amend a system of records notice in its existing...
Full Text Available Big Data Analytics (BDA is important to utilize data from hospital systems to reduce healthcare costs. BDA enable queries of large volumes of patient data in an interactively dynamic way for healthcare. The study objective was high performance establishment of interactive BDA platform of hospital system. A Hadoop/MapReduce framework was established at University of Victoria (UVic with Compute Canada/Westgrid to form a Healthcare BDA (HBDA platform with HBase (NoSQL database using hospital-specific metadata and file ingestion. Patient data profiles and clinical workflow derived from Vancouver Island Health Authority (VIHA, Victoria, BC, Canada. The proof-of-concept implementation tested patient data representative of the entire Provincial hospital systems. We cross-referenced all data profiles and metadata with real patient data used in clinical reporting. Query performance tested Apache tools in Hadoop’s ecosystem. At optimized iteration, Hadoop Distributed File System (HDFS ingestion required three seconds but HBase required four to twelve hours to complete the Reducer of MapReduce. HBase bulkloads took a week for one billion (10TB and over two months for three billion (30TB. Simple and complex query results showed about two seconds for one and three billion, respectively. Apache Drill outperformed Apache Spark. However, it was restricted to running more simplified queries with poor usability for healthcare. Jupyter on Spark offered high performance and customization to run all queries simultaneously with high usability. BDA platform of HBase distributed over Hadoop successfully; however, some inconsistencies of MapReduce limited operational efficiencies. Importance of Hadoop/MapReduce on representation of platform performance discussed.
National Archives and Records Administration — RCPBS supports the Records center programs (RCP) in producing invoices for the storage (NARS-5) and servicing of National Archives and Records Administrationâs...
Libby MM Morris
Full Text Available Background In Scotland, out-of-hours calls are all triaged by the National Health Service emergency service (NHS24 but the clinicians receiving calls have no direct access to patient records.Objective To improve the safety of patient care in unscheduled consultations when the usual primary care record is not available.Technology The Emergency Care Summary (ECS is a record system offering controlled access to medication and adverse reactions details for nearly every person registered with a general practice in Scotland. It holds a secure central copy of these parts of the GP practice record and is updated automatically twice daily. It is accessible under specified unplanned clinical circumstances by clinicians working in out-of-hours organisations, NHS24 and accident and emergency departments if they have consent from the patient and a current legitimate relationship for that patient’s care.Application We describe the design of the security model, management of data quality, deployment, costs and clinical benefits of the ECS over four years nationwide in Scotland, to inform the debate on the safe and effective sharing of health data in other nations.Evaluation Forms were emailed to 300 NHS24 clinicians and 81% of the 113 respondents said that the ECS was helpful or very helpful and felt that it changed their clinical management in 20% of cases.Conclusion The ECS is acceptable to patients and helpful for clinicians and is used routinely for unscheduled care when normal medical records are unavailable. Benefits include more efficient assessment and reduced drug interaction, adverse reaction and duplicate prescribing.
Flemming, Daniel; Hübner, Ursula
Establishing continuity of care in handovers at changes of shift is a challenging endeavor that is jeopardized by time pressure and errors typically occurring during synchronous communication. Only if the outgoing and incoming persons manage to collaboratively build a common ground for the next steps of care is it possible to ensure a proper continuation. Electronic systems, in particular electronic patient record systems, are powerful providers of information but their actual use might threaten achieving a common understanding of the patient if they force clinicians to work asynchronously. In order to gain a deeper understanding of communication failures and how to overcome them, we performed a systematic review of the literature, aiming to answer the following four research questions: (1a) What are typical errors and (1b) their consequences in handovers? (2) How can they be overcome by conventional strategies and instruments? (3) electronic systems? (4) Are there any instruments to support collaborative grounding? We searched the databases MEDLINE, CINAHL, and COCHRANE for articles on handovers in general and in combination with the terms electronic record systems and grounding that covered the time period of January 2000 to May 2012. The search led to 519 articles of which 60 were then finally included into the review. We found a sharp increase in the number of relevant studies starting with 2008. As could be documented by 20 studies that addressed communication errors, omission of detailed patient information including anticipatory guidance during handovers was the greatest problem. This deficiency could be partly overcome by structuring and systematizing the information, e.g. according to Situation, Background, Assessment and Recommendation schema (SBAR), and by employing electronic tools integrated in electronic records systems as 23 studies on conventional and 22 articles on electronic systems showed. Despite the increase in quantity and quality of the
Research objective. Electronic Health Records (EHR) are expected to transform the way medicine is delivered with patients/consumers being the intended beneficiaries. However, little is known regarding patient knowledge and attitudes about EHRs. This study examined patient perceptions about EHR. Study design. Surveys were administered following…
Takeda, Hiroshi; Matsumura, Yasushi; Kuwata, Shigeki; Nakano, Hirohiko; Shanmai, Ji; Qiyan, Zhang; Yufen, Chen; Kusuoka, Hideo; Matsuoka, Masaki
To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.
Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette
Introduction In order to give patients possibility to listen to their consultation again, we have designed a system which gives the patients access to digital audio recordings of their consultations. An Interactive Voice Response platform enables the audio recording and gives the patients access...... and those who have not (control).The audio recordings and the interviews are coded according to six themes: Test results, Treatment, Risks, Future tests, Advice and Plan. Afterwards the extent of patients recall is assessed by comparing the accuracy of the patient’s statements (interview...
Marcos, Carlos; González-Ferrer, Arturo; Peleg, Mor; Cavero, Carlos
We show how the HL7 Virtual Medical Record (vMR) standard can be used to design and implement a data integrator (DI) component that collects patient information from heterogeneous sources and stores it into a personal health record, from which it can then retrieve data. Our working hypothesis is that the HL7 vMR standard in its release 1 version can properly capture the semantics needed to drive evidence-based clinical decision support systems. To achieve seamless communication between the personal health record and heterogeneous data consumers, we used a three-pronged approach. First, the choice of the HL7 vMR as a message model for all components accompanied by the use of medical vocabularies eases their semantic interoperability. Second, the DI follows a service-oriented approach to provide access to system components. Third, an XML database provides the data layer.Results The DI supports requirements of a guideline-based clinical decision support system implemented in two clinical domains and settings, ensuring reliable and secure access, high performance, and simplicity of integration, while complying with standards for the storage and processing of patient information needed for decision support and analytics. This was tested within the framework of a multinational project (www.mobiguide-project.eu) aimed at developing a ubiquitous patient guidance system (PGS). The vMR model with its extension mechanism is demonstrated to be effective for data integration and communication within a distributed PGS implemented for two clinical domains across different healthcare settings in two nations. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: email@example.com.
Martin, J.B.; Lyon, M.
Radiation protection records are a fundamental part of any program for protecting radiation workers. Records are essential to epidemiological studies of radiation workers and are becoming increasingly important as the number of radiation exposure litigation cases increases. Ready retrievability of comprehensive records is also essential to the adequate defense of a radiation protection program. Appraisals of numerous radiation protection programs have revealed that few record-keeping systems comply with American National Standards Institute, Standard Practice N13.6-1972. Record-keeping requirements and types of deficiencies in radiation protection records systems are presented in this paper, followed by general recommendations for implementing a comprehensive radiation protection records system
Martin, J.B.; Lyon, M.
Radiation protection records are a fundamental part of any program for protecting radiation workers. Records are essential to epidemiological studies of radiation workers and are becoming increasingly important as the number of radiation exposure litigation cases increases. Ready retrievability of comprehensive records is also essential to the adequate defense of a radiation protection program. Appraisals of numerous radiation protection programs have revealed that few record-keeping systems comply with American National Standards Institute, Standard Practice N13.6-1972. Record-keeping requirements and types of deficiencies in radiation protection records systems are presented in this paper, followed by general recommendations for implementing a comprehensive radiation protection records system. 8 refs
Li, Bo; Gao, Hong-yang; Gao, Rui; Zhao, Ying-pan; Li, Qing-na; Zhao, Yang; Tang, Xu-dong; Shang, Hong-cai
Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system. A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases, i.e. PubMed, Excerpt Medica Database, China Biology Medicine disc and China National Knowledge Infrastructure. However, no relevant study on the subjects of interest was identified. Therefore, drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine, we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial. Further, we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders. Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research. The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.
Shemeikka, Tero; Bastholm-Rahmner, Pia; Elinder, Carl-Gustaf; Vég, Anikó; Törnqvist, Elisabeth; Cornelius, Birgitta; Korkmaz, Seher
To develop and verify proof of concept for a clinical decision support system (CDSS) to support prescriptions of pharmaceutical drugs in patients with reduced renal function, integrated in an electronic health record system (EHR) used in both hospitals and primary care. A pilot study in one geriatric clinic, one internal medicine admission ward and two outpatient healthcare centers was evaluated with a questionnaire focusing on the usefulness of the CDSS. The usage of the system was followed in a log. The CDSS is considered to increase the attention on patients with impaired renal function, provides a better understanding of dosing and is time saving. The calculated glomerular filtration rate (eGFR) and the dosing recommendation classification were perceived useful while the recommendation texts and background had been used to a lesser extent. Few previous systems are used in primary care and cover this number of drugs. The global assessment of the CDSS scored high but some elements were used to a limited extent possibly due to accessibility or that texts were considered difficult to absorb. Choosing a formula for the calculation of eGFR in a CDSS may be problematic. A real-time CDSS to support kidney-related drug prescribing in both hospital and outpatient settings is valuable to the physicians. It has the potential to improve quality of drug prescribing by increasing the attention on patients with renal insufficiency and the knowledge of their drug dosing. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
... regarding current and future health care. Removing barriers to a veteran's access to VA records will support... patient autonomy and shared decision making. Removing this regulation will directly benefit veterans by... property, Infants and children, Inventions and patents, Parking, Penalties, Privacy, Reporting and...
Department of Veterans Affairs — Occupational Health Record-keeping System (OHRS) is part of the Clinical Information Support System (CISS) portal framework and the initial CISS partner system. OHRS...
Basavatia, A; Kalnicki, S; Garg, M; Lukaj, A; Hong, L; Fret, J; Yaparpalvi, R; Tome, W
Purpose: To implement a clinically useful palm vein pattern recognition biometric system to treat the correct treatment plan to the correct patient each and every time and to check-in the patient into the department to access the correct medical record. Methods: A commercially available hand vein scanning system was paired to Aria and utilized an ADT interface from the hospital electronic health system. Integration at two points in Aria, version 11 MR2, first at the appointment tracker screen for the front desk medical record access and second at the queue screen on the 4D treatment console took place for patient daily time-out. A test patient was utilized to check accuracy of identification as well as to check that no unintended interactions take place between the 4D treatment console and the hand vein scanning system. This system has been in clinical use since December 2013. Results: Since implementation, 445 patients have been enrolled into our biometric system. 95% of patients learn the correct methodology of hand placement on the scanner in the first try. We have had two instances of patient not found because of a bad initial scan. We simply erased the scanned metric and the patient enrolled again in those cases. The accuracy of the match is 100% for each patient, we have not had one patient misidentified. We can state this because we still use patient photo and date of birth as identifiers. A QA test patient is run monthly to check the integrity of the system. Conclusion: By utilizing palm vein scans along with the date of birth and patient photo, another means of patient identification now exits. This work indicates the successful implementation of technology in the area of patient safety by closing the gap of treating the wrong plan to a patient in radiation oncology. FOJP Service Corporation covered some of the costs of the hardware and software of the palm vein pattern recognition biometric system
Basavatia, A; Kalnicki, S; Garg, M; Lukaj, A; Hong, L [Montefiore Medical Center, Bronx, NY (United States); Fret, J [Montefiore Information Technology, Yonkers, NY (United States); Yaparpalvi, R [Montefiore Medical Center, Bronx, NY (United States); Montefiore Medical Center, Bronx, NY (United States); Tome, W [Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (United States)
Purpose: To implement a clinically useful palm vein pattern recognition biometric system to treat the correct treatment plan to the correct patient each and every time and to check-in the patient into the department to access the correct medical record. Methods: A commercially available hand vein scanning system was paired to Aria and utilized an ADT interface from the hospital electronic health system. Integration at two points in Aria, version 11 MR2, first at the appointment tracker screen for the front desk medical record access and second at the queue screen on the 4D treatment console took place for patient daily time-out. A test patient was utilized to check accuracy of identification as well as to check that no unintended interactions take place between the 4D treatment console and the hand vein scanning system. This system has been in clinical use since December 2013. Results: Since implementation, 445 patients have been enrolled into our biometric system. 95% of patients learn the correct methodology of hand placement on the scanner in the first try. We have had two instances of patient not found because of a bad initial scan. We simply erased the scanned metric and the patient enrolled again in those cases. The accuracy of the match is 100% for each patient, we have not had one patient misidentified. We can state this because we still use patient photo and date of birth as identifiers. A QA test patient is run monthly to check the integrity of the system. Conclusion: By utilizing palm vein scans along with the date of birth and patient photo, another means of patient identification now exits. This work indicates the successful implementation of technology in the area of patient safety by closing the gap of treating the wrong plan to a patient in radiation oncology. FOJP Service Corporation covered some of the costs of the hardware and software of the palm vein pattern recognition biometric system.
Roč. 22, č. 1 (2002), s. 43-60 ISSN 0208-5216 R&D Projects: GA MŠk LN00B107 Keywords : medical informatics * tekemedicine * electronic health record * electronic medical guidelines * decision-support systems * cardiology Subject RIV: BD - Theory of Information
Quantin, Catherine; Jaquet-Chiffelle, David-Olivier; Coatrieux, Gouenou; Benzenine, Eric; Allaert, François-André
The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities. Copyright Â© 2010 Elsevier Ireland Ltd. All rights reserved.
Matos, L; Teixeira, M A; Henriques, A; Tavares, M M; Alvares, L; Antunes, A; Amaral, Teresa F
The prevalence of disease-related malnutrition (DRM) is described to be of 30-60% on admission to hospital, and of 10% in the community. It has been associated with worse clinical outcomes, namely higher morbidity and mortality as well as higher frequency of health care and its associated costs. The lack of screening and monitoring of nutritional status have been said to be risk factors for the increased prevalence of DRM during hospital stay. The aims of this study were to evaluate the importance given by health care professionals to certain aspects related with nutritional status (weight, food intake) of hospital patients and to see if there were any differences between the under and non undernourished ones. A systematic sample of patients from six hospitals was collected. Pregnancy, paediatric age and critical illness were exclusion criteria as well as incapacity to fulfil nutritional risk screening protocol and length-of-stay less than 24h. Socio-demographic, anthropometric data and clinical notes (e.g. weight, food/nutrient intake) from medical records were collected and Nutritional Risk Screening 2002 protocol was applied. A total of 1152 patients were included in this study. The prevalence of nutritional risk varied between 28.5% and 47.3% while undernutrition classified by anthropometrical parameters was considerably lower (6.3% to 14.9%). Two thirds of the patients had their food intake monitored and registered in medical records but only one third were weighted. Undernourished patients had their food intake more frequently monitored but their weight was less frequently measured, than the well-nourished ones. DRM prevalence amongst hospital patients on admission is significantly high. Clinical notes regarding nutritional status is rather infrequent on medical records. This study showed that urges the need to empower health care providers of the importance of the screening and monitoring of weight and food intake, on admission and during hospital stay.
Lawson, B.J.; Farrell, L.; Meacham, C.; Tapio, J.
System integration is the process where through networking and/or software development, necessary business information is available in a common computing environment. System integration is becoming an important objective for many businesses. System integration can improve productivity and efficiency, reduce redundant stored information and errors, and improve availability of information. This paper will discuss the information flow in a radiation health environment, and how system integration can help. Information handled includes external dosimetry and internal dosimetry. The paper will focus on an ORACLE based system integration software product
Liu, Brent J.; Winstein, Carolee; Wang, Ximing; Konersman, Matt; Martinez, Clarisa; Schweighofer, Nicolas
Stroke is one of the major causes of death and disability in America. After stroke, about 65% of survivors still suffer from severe paresis, while rehabilitation treatment strategy after stroke plays an essential role in recovery. Currently, there is a clinical trial (NIH award #HD065438) to determine the optimal dose of rehabilitation for persistent recovery of arm and hand paresis. For DOSE (Dose Optimization Stroke Evaluation), laboratory-based measurements, such as the Wolf Motor Function test, behavioral questionnaires (e.g. Motor Activity Log-MAL), and MR, DTI, and Transcranial Magnetic Stimulation (TMS) imaging studies are planned. Current data collection processes are tedious and reside in various standalone systems including hardcopy forms. In order to improve the efficiency of this clinical trial and facilitate decision support, a web-based imaging informatics system has been implemented together with utilizing mobile devices (eg, iPAD, tablet PC's, laptops) for collecting input data and integrating all multi-media data into a single system. The system aims to provide clinical imaging informatics management and a platform to develop tools to predict the treatment effect based on the imaging studies and the treatment dosage with mathematical models. Since there is a large amount of information to be recorded within the DOSE project, the system provides clinical data entry through mobile device applications thus allowing users to collect data at the point of patient interaction without typing into a desktop computer, which is inconvenient. Imaging analysis tools will also be developed for structural MRI, DTI, and TMS imaging studies that will be integrated within the system and correlated with the clinical and behavioral data. This system provides a research platform for future development of mathematical models to evaluate the differences between prediction and reality and thus improve and refine the models rapidly and efficiently.
Dullabh, Prashila M; Sondheimer, Norman K; Katsh, Ethan; Evans, Michael A
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
Hofmann, Holger; Dambach, S.Soeren; Richter, Hartmut
The migration paths from DVD phase change recording with red laser to the next generation optical disk formats with blue laser and high NA optics are discussed with respect to optical aberration margins and disc capacities. A test system for the evaluation of phase change disks with more than 20 GB capacity is presented and first results of the recording performance are shown
Full Text Available Introduction: Oncology patients need extensive follow-up and meticulous documentation. The aim of this study was to introduce a simple, platform independent file based system for documentation of diagnostic and therapeutic procedures in oncology patients and test its function.Material and methods: A file-name based system of the type M1M2M3.F2 was introduced, where M1 is a unique identifier for the patient, M2 is the date of the clinical intervention/event, M3 is an identifier for the author of the medical record and F2 is the specific software generated file-name extension.Results: This system is in use at 5 institutions, where a total of 11 persons on 14 different workstations inputted 16591 entries (files for 2370. The merge process was tested on 2 operating systems - when copied together all files sort up as expected by patient, and for each patient in a chronological order, providing a digital cumulative patient record, which contains heterogeneous file formats.Conclusion: The file based approach for storing heterogeneous digital patient related information is an reliable system, which can handle open-source, proprietary, general and custom file formats and seems to be easily scalable. Further development of software for automatic checks of the integrity and searching and indexing of the files is expected to produce a more user-friendly environment
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
... 42 Public Health 5 2010-10-01 2010-10-01 false Patient health records. 491.10 Section 491.10...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.10 Patient health records. (a) Records... systematically organized. (3) For each patient receiving health care services, the clinic or center maintains a...
Masiza, Melissa; Mostert-Phipps, Nicky; Pottasa, Dalenca
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.
Lyon, M.; Berndt, V.L.; Trevino, G.W.; Oakley, B.M.
The Hanford Radiological Records Program (HRRP) serves all Hanford contractors as the single repository for radiological exposure for all Hanford employees, subcontractors, and visitors. The program administers and preserves all Hanford radiation exposure records. The program also maintains a Radiation Protection Historical File which is a historical file of Hanford radiation protection and dosimetry procedures and practices. Several years ago DOE declared the existing UNIVAC mainframe computer obsolete and the existing Occupational Radiation Exposure (ORE) system was slated to be redeveloped. The new system named the Radiological Exposure (REX) System is described in this document
Full Text Available The aim of this poster is to illustrate the South African National Recordal Systems (NRS) process whereby Indigenous Knowledge (IK) holder’s information is captured in a registry, as specified in South Africa’s Indigenous Knowledge Systems Policy...
... DEPARTMENT OF STATE [Public Notice 8384] Privacy Act; System of Records: Human Resources Records... system of records, Human Resources Records, State- 31, pursuant to the provisions of the Privacy Act of... State proposes that the current system will retain the name ``Human Resources Records'' (previously...
Full Text Available good, based on IK.? Subsequently, the South African Department of Science and Technology (DST) created a National Indigenous Knowledge Systems Office (NIKSO) that is taking the lead on interfacing IKS with other recognised knowledge holders... is to illustrate the South African National Recordal Systems (NRS) process whereby Indigenous Knowledge (IK) holder?s information is captured in a registry, as specified in South Africa?s Indigenous Knowledge Systems (IKS) Policy, through an IK cataloguing...
Full Text Available By November 2015, the West Africa Ebola epidemic had caused 28598 infections and 11299 deaths in the three countries most affected. The outbreak required rapid innovation and adaptation. Médecins sans Frontières (MSF scaled up its usual 20-30 bed Ebola management centres (EMCs to 100-300 beds with over 300 workers in some settings. This brought challenges in patient and clinical data management resulting from the difficulties of working safely with high numbers of Ebola patients. We describe a project MSF established with software developers and the Google Social Impact Team to develop context-adapted tools to address the challenges of recording Ebola clinical information. We share the outcomes and key lessons learned in innovating rapidly under pressure in difficult environmental conditions. Information on adoption, maintenance, and data quality was gathered through review of project documentation, discussions with field staff and key project stakeholders, and analysis of tablet data. In March 2015, a full prototype was deployed in Magburaka EMC, Sierra Leone. Inpatient data were captured on 204 clinical interactions with 34 patients from 5 March until 10 April 2015. Data continued to also be recorded on paper charts, creating theoretically identical record “pairs” on paper and tablet. 83 record pairs for 33 patients with 22 data items (temperature and symptoms per pair were analysed. The overall Kappa coefficient for agreement between sources was 0.62, but reduced to 0.59 when rare bleeding symptoms were excluded, indicating moderate to good agreement. The time taken to deliver the product was more than that anticipated by MSF (7 months versus 6 weeks. Deployment of the tablet coincided with a dramatic drop in patient numbers and thus had little impact on patient care. We have identified lessons specific to humanitarian-technology collaborative projects and propose a framework for emergency humanitarian innovation. Time and effort is
Francisco S Roque
Full Text Available Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracting phenotype information from the free-text in such records we demonstrate that we can extend the information contained in the structured record data, and use it for producing fine-grained patient stratification and disease co-occurrence statistics. The approach uses a dictionary based on the International Classification of Disease ontology and is therefore in principle language independent. As a use case we show how records from a Danish psychiatric hospital lead to the identification of disease correlations, which subsequently can be mapped to systems biology frameworks.
... respective personnel management and finance systems.'' Routine uses of records maintained in the system...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to Alter a System of Records. SUMMARY: The Defense Logistics Agency proposes to alter a system of records in its inventory of record...
Niimi, Yukari; Ota, Katsumasa
To provide adequate care, medical professionals have to collect not only medical information but also information that may be related to private aspects of the patient's life. With patients' increasing awareness of information privacy, healthcare providers have to pay attention to the patients' right of privacy. This study aimed to clarify the requirements of the display method of electronic patient record (EPR) screens in consideration of both patients' information privacy concerns and health professionals' information needs. For this purpose, semi-structured group interviews were conducted of 78 medical professionals. They pointed out that partial concealment of information to meet patients' requests for privacy could result in challenges in (1) safety in healthcare, (2) information sharing, (3) collaboration, (4) hospital management, and (5) communication. They believed that EPRs should (1) meet the requirements of the therapeutic process, (2) have restricted access, (3) provide convenient access to necessary information, and (4) facilitate interprofessional collaboration. This study provides direction for the development of display methods that balance the sharing of vital information and protection of patient privacy.
Ohmura, Hayato; Kitasuka, Teruaki; Aritsugi, Masayoshi; オオムラ, ハヤト; キタスカ, テルアキ; アリツギ, マサヨシ; 大村, 勇人; 北須賀, 輝明; 有次, 正義
In this paper, we introduce a Web browsing behavior recording system for research. Web browsing behavior data can help us to providesophisticated services for human activities, because the data must indicate characteristics ofWeb users.We discuss the necessity of the data with potential benefits, and develop a system for collecting the data as an add-on for Firefox. We also report some results of preliminary experiments to test its usefulness in analyses on human activities in this paper.
Ohuchi, J.; Torata, S.; Tsuboya, T.
Long-term record preservation system on geological disposal of High Level Radioactive Wastes (HLW) has been investigated as the institutional control by RWMC, Japan. Geological disposal of HLW, being based on the passive safe concept, has been considered not to necessitate the human controls to maintain its long-term safety. However how to complement the safety case on geological disposal is an important issue in each countries to progress the repository program with the step-wise decisions process during the long-term period up to several hundreds years. Although we cannot predict the future society, we need to realize the robust and redundant system for preserving records, which should be accessible, retrievable and understandable for the unpredicted future generations. First of all, we held a Rome workshop in January 2003 to exchange views on the matter, resulted in the suggestion directing the discussion on the record management and long-term preservation and retrieval of information regarding radioactive waste. Second, we considered the balance of active and passive system to strengthen the robustness. Another significance of long-term record preservation is to send current generation an implicit message, 'doing our best for future generations', in addition to aiming at both warning and their own decision-making. We call it 'meta-signal' to current generation. Thirdly, we demonstrated the laser-engraving technology to have converted five hundreds pages of an A4 sized report with human readable font sizes to 42 square silicon carbide plates, 10cm x10cm and 1mm in thickness. Silicon carbide would be an alternative to paper and might be possible to be an alternative to microfilm utilized as digital recording media. Another case study is the future generations' accessibility to the preserved records. (author)
Wang, Jong-Yi; Ho, Hsiao-Yun; Chen, Jen-De; Chai, Sinkuo; Tai, Chih-Jaan; Chen, Yung-Fu
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
... two existing systems of records. The two existing systems of records are ``Administrative Audit System... existing systems of records, ``Administrative Audit System (SEC-14)'' and ``Fitness Center Membership... Audit System (SEC-14) records are used to ensure that all obligations and expenditures other than those...
Tall, Jill M; Hurd, Marie; Gifford, Thomas
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.
Despite the enormous progress that is made, many healthcare professionals still experience problems regarding patient information and patient records. For a long time the expectation is that an electronic patient record (EPR) will solve these problems. In this research the factors determining the
Learn more about the EPA Telecommunications Detail Records System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedures.
Learn about the Employee Counseling and Assistance Program Records System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedures.
Full Text Available Abstract Background Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine available to patients over the Internet in a project involving more than half of renal units in the UK. Methods Content and presentation of the Renal PatientView (RPV system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (90 yrs but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular
Bartlett, Cherry; Simpson, Keith; Turner, A Neil
Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrollment and usage were extracted from the webserver. By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enroll each patient. Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no
Ludwig, C A
Computer-based clinical information systems are capable of effectively processing even large amounts of patient-related data. However, physicians depend on rapid access to summarized, clearly laid out data on the computer screen to inform themselves about a patient's current clinical situation. In introducing a clinical workplace system, we therefore transformed the problem list-which for decades has been successfully used in clinical information management-into an electronic equivalent and integrated it into the medical record. The table contains a concise overview of diagnoses and problems as well as related findings. Graphical information can also be integrated into the table, and an additional space is provided for a summary of planned examinations or interventions. The digital form of the problem list makes it possible to use the entire list or selected text elements for generating medical documents. Diagnostic terms for medical reports are transferred automatically to corresponding documents. Computer technology has an immense potential for the further development of problem list concepts. With multimedia applications sound and images will be included in the problem list. For hyperlink purpose the problem list could become a central information board and table of contents of the medical record, thus serving as the starting point for database searches and supporting the user in navigating through the medical record.
... Services Contractor Records SUMMARY: Notice is hereby given that the Department of State proposes to create a new system of records, Personal Services Contractor Records, State-76, pursuant to the provisions... July 20, 2011. It is proposed that the new system be named ``Personal Services Contractor Records.'' It...
...) deletes one system of records from its existing inventory of systems of records subject to the Privacy Act... inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. The deletion is... following system of records is deleted: 1. (18-04-03) ED Web Personalization Pilot Data Collection, 66 FR...
...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Contract Audit Agency is proposing to amend a system of records notice in its... INFORMATION: The Defense Contract Audit Agency systems of records notices subject to the Privacy Act of 1974...
...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to alter a System of Records. SUMMARY: The Defense Contract Audit Agency proposes to alter a system of records in its inventory of.... SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency notices for systems of records subject to the...
...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Contract Audit Agency is amending a system of records notice in its existing.... SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency systems of records notices subject to the Privacy...
...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Contract Audit Agency is proposing to amend a system of records notice in its... INFORMATION: The Defense Contract Audit Agency systems of records notices subject to the Privacy Act of 1974...
...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Contract Audit Agency is amending a system of records notice in its existing.... SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency systems of records notices subject to the Privacy...
...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to alter a System of Records. SUMMARY: The Defense Contract Audit Agency proposes to alter a system of records in its inventory of.... SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency notices for systems of records subject to the...
...) is amending the system of records currently entitled ``Veterans Health Information Systems and... Health Information Systems and Technology Architecture (VistA) Records-VA ROUTINE USES OF RECORDS... DEPARTMENT OF VETERANS AFFAIRS Privacy Act of 1974; System of Records AGENCY: Department of...
... Logistics Agency Primary Level Field Activities. Addresses may be obtained from the System manager below...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice To Amend a System of Records. SUMMARY: The Defense Logistics Agency is proposing to amend a system of records in its inventory of record...
...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete a system of records. SUMMARY: The Defense Finance and Accounting Service is deleting a system of records.... SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the...
...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete a Systems of Records. SUMMARY: The Defense Finance and Accounting Service is deleting a system of records.... SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the...
...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete two Systems of Records. SUMMARY: The Defense Finance and Accounting Service is deleting two systems of records...: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of...
...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete two Systems of Records. SUMMARY: The Defense Finance and Accounting Service is deleting two systems of records...: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of...
...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete a system of records. SUMMARY: The Defense Finance and Accounting Service is deleting a system of records... INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act...
...; System of Records AGENCY: Defense Finance and Accounting Service. ACTION: Notice to delete two systems of records. SUMMARY: The Defense Finance and Accounting Service is deleting two systems of records notices in.... SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the...
...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records... Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of 1974 (5 U...
... Control Records system of records is also covered by the Defense Finance and Accounting System T7330a... Defense Finance and Accounting System T7332, Defense Debt Management System (February 17, 2009, 74 FR 7665...
Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René
OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...
... DEPARTMENT OF STATE [Public Notice 8066] Privacy Act; System of Records: Translator and... an existing system of records, Translator and Interpreter Records, State-37, pursuant to the... INFORMATION: The Department of State proposes that the current system will retain the name ``Translator and...
... signature and encryption certificates for documents and email and to add biometric authentication... National Archives Records Administration--Schedules for the type of record being maintained. System manager...
Houben, Steven; Frost, Mads; Bardram, Jakob E
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...
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Security of systems of records. 16.51... Security of systems of records. (a) Each component shall establish administrative and physical controls to prevent unauthorized access to its systems of records, to prevent unauthorized disclosure of records, and...
... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Security of records systems. 103.34 Section 103.34 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS POWERS AND DUTIES; AVAILABILITY OF RECORDS § 103.34 Security of records systems. The security of records systems...
The Records Inventory Management System (RIMS) is a computer library of abstracted documents relating to low-level radioactive waste. The documents are of interest to state governments, regional compacts, and the Department of Energy, especially as they relate to the Low-Level Radioactive Waste Policy Act requiring states or compacts of states to establish and operate waste disposal facilities. RIMS documents are primarily regulatory, policy, or technical documents, published by the various states and compacts of the United States; however, RIMS contains key international publications as well. The system has two sections: a document retrieval section and a document update section. The RIMS mainframe can be accessed through a PC or modem. Also, each state and compact may request a PC version of RIMS, which allows a user to enter documents off line and then upload the documents to the mainframe data base
... records in the system: Storage: Paper records and electronic storage media. Retrievability: Name, Social... include name, Social Security Number (SSN), enlisted service number, date of birth, rate, rank, record... and motivation, and other career related matters to meet [[Page 21261
... automated records maintained by Space and Warfare Systems Center Atlantic.'' * * * * * Retention and... Education and Training Records.'' * * * * * N07220-1 System name: Navy Standard Integrated Personnel System...), date of birth, education, training and qualifications, professional history, assignments, performance...
... a System of Records. SUMMARY: The National Security Agency (NSA) is amending a system of records... Officer, Department of Defense. GNSA 06 System Name: NSA/CSS Health, Medical and Safety Files (February 10... of the NSA/CSS compilation of system of records notices apply to this system.'' * * * * * Storage...
Vaughon, Wendy L; Czaja, Sara J; Levy, Joslyn; Rockoff, Maxine L
Background Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually
Heep, H.; Buelow-Johansen, T.; Klemencic, J.; Wegwitz, J.; Stadtkrankenhaus Offenbach
Patient dose during mammography for various recording systems, such as film, film-screen combination and xeromammography was measured by thermoluminescent densitometers. In the first set of experiments we measured dose per exposure, in a second set total surface dose at five points on the breast, using the following combintions: a) Two industrial film exposures and one xeromammographic exposure. b) two film-screen exposures and one xeromammographic exposure. c) One industrial film and two xeromammographic exposures. (orig.) [de
Goudra, B; Singh, P M; Borle, A; Gouda, G
Use of electronic medical record systems has increased in the recent years. Epic is one such system gaining popularity in the USA. Epic is a private company, which invented the electronic documentation system adopted in our hospital. In spite of many presumed advantages, its use is not critically analyzed. Some of the perceived advantages are increased efficiency and protection against litigation as a result of accurate documentation. In this study, retrospective data of 305 patients who underwent endoscopic retrograde cholangiopancreatography (wherein electronic charting was used - "Epic group") were compared with 288 patients who underwent the same procedure with documentation saved on a paper chart ("paper group"). Time of various events involved in the procedure such as anesthesia start, endoscope insertion, endoscope removal, and transfer to the postanesthesia care unit were routinely documented. From this data, the various time durations were calculated. Both "anesthesia start to scope insertion" times and "scope removal to transfer" times were significantly less in the Epic group compared to the paper group. Use of Epic system led to a saving of 4 min of procedure time per patient. However, the mean oxygen saturation was significantly less in the Epic group. In spite of perceived advantages of Epic documentation system, significant hurdles remain with its use. Although the system allows seamless flow of patients, failure to remove all artifacts can lead to errors and become a source of potential litigation hazard.
... a system of records, Risk Analysis and Management Records, State-78, pursuant to the provisions of... INFORMATION: The Department of State proposes that the new system will be ``Risk Analysis and Management.... These standard routine uses apply to State-78, Risk Analysis and Management Records. POLICIES AND...
... Defense Intelligence Information System (DoDIIS) Customer Relationship Management System. The records will... instructions for submitting comments. * Mail: Federal Docket Management System Office, 4800 Mark Center Drive...
Before digital records can be preserved or managed, they need to be identified first. However, records identification is not a clearly defined process. Given the multi-faceted information system environment in organisations, large quantities of potential records are created and stored in systems not designed for records ...
... characteristics (such as name, last four digits of Social Security Number (SSN), grade, Unit Identification Code...) organization. CATEGORIES OF RECORDS IN THE SYSTEM: Name, last four digits of Social Security Number (SSN), duty... RECORDS IN THE SYSTEM: STORAGE: Records are stored on electronic storage media. RETRIEVABILITY: Records...
... obsolete. The records are now covered by the Defense Finance and Accounting Service system of records... Defense Finance and Accounting Service system of records notice, T-7206, Non-appropriated Funds Central... Cards (February 22, 1993, 58 FR 10562). Reason: These records are now covered by the Defense Finance and...
... number.'' CONTESTING RECORD PROCEDURES: Delete entry and replace with ``The NSA/CSS rules for contesting...' published at the beginning of the NSA/CSS's compilation of record systems also apply to this record system... number. CONTESTING RECORD PROCEDURES: The NSA/CSS rules for contesting contents and appealing initial...
... users are given cyber security awareness training which covers the procedures for handling Sensitive but.... State-09 SYSTEM NAME: Equal Employment Opportunity Records. SECURITY CLASSIFICATION: Unclassified... apply to the Equal Employment Opportunity Records, State-09. DISCLOSURE TO CONSUMER REPORTING AGENCIES...
... or be supplied with copies by mail. (b) Requests pertaining to records contained in a system of... Financial Disclosure Reports and Other Ethics Program Records), OGE/GOVT-2 (Confidential Statements of...
...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to delete a Systems of Records. SUMMARY: The Defense Contract Audit Agency (DCAA) is deleting a system of records in its existing... at (703) 767-1022. SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency (DCAA) systems of...
... testing, or permanent implementation, as applicable. System manager(s) and address: Defense Logistics...; Systems of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Logistics Agency proposes to amend a system of records notice in its existing...
... determination is made. System manager(s) and address: Personnel Security Specialists, Defense Logistics Agency...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to Amend Two Systems of Records. SUMMARY: The Defense Logistics Agency is proposing to amend two systems of records notices in its existing...
.... System manager(s) and address: Director, DLA Human Resources, Headquarters, Defense Logistics Agency...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Logistics Agency is proposing to amend a system of records notice in its existing...
....'' * * * * * System manager(s) and address: Delete entry and replace with ``Director, Defense Logistics Agency Human...; System of Records AGENCY: Defense Logistics Agency, Department of Defense (DoD). ACTION: Notice to amend a system of records. SUMMARY: The Defense Logistics Agency is proposing to amend a system of records...
... DEPARTMENT OF COMMERCE [Docket No. 130520483-3483-01] Privacy Act New System of Records AGENCY... Department's proposal for a new system of records under the Privacy Act. The system is entitled ``Information... Department is creating a new system of records that will enable electronic registration, via the Internet...
... Affairs (VA) is amending the system of records entitled ``Alternative Dispute Resolution Tracking System... records entitled ``Alternative Dispute Resolution Tracking System-VA'' (116VA09) in 67 FR 49392-49395 (July 30, 2002). The system of records tracked alternative dispute resolution (ADR) activity within VA...
... National Defense Intelligence College. Categories of records in the system: Name, date of birth and Social... States Commission on Higher Education Association Characteristics of Excellence in Higher Education... system: Storage: Electronic storage media. Retrievability: By last name. Safeguards: Records are...
... by Defense Finance and Accounting Service (DFAS) and is covered by DFAS Systems of Records Notice T5500b, Integrated Garnishment System (IGS) (September 19, 2012, 77 FR 58106). Paper records previously...
Houben, Steven; Schmidt, Mathias; Frost, Mads
Despite the widespread dissemination of the electronic health record, the paper medical record remains an important central artefact in modern clinical work. A number of new technological solutions have been proposed to mitigate some of the configuration, mobility and awareness problems that emerge...... when using this dual record setup. In this paper, we present one such technology, the HyPR device, in which a paper record is augmented with an electronic sensing platform that is designed to reduce the configuration overhead, provide awareness cues and support mobility across the patient ward. Our...
Christiansen, Ellen K; Skipenes, Eva; Hausken, Marie F; Skeie, Svein; Østbye, Truls; Iversen, Marjolein M
Use of shared electronic health records opens a whole range of new possibilities for flexible and fruitful cooperation among health personnel in different health institutions, to the benefit of the patients. There are, however, unsolved legal and security challenges. The overall aim of this article is to highlight legal and security challenges that should be considered before using shared electronic cooperation platforms and health record systems to avoid legal and security "surprises" subsequent to the implementation. Practical lessons learned from the use of a web-based ulcer record system involving patients, community nurses, GPs, and hospital nurses and doctors in specialist health care are used to illustrate challenges we faced. Discussion of possible legal and security challenges is critical for successful implementation of shared electronic collaboration systems. Key challenges include (1) allocation of responsibility, (2) documentation routines, (3) and integrated or federated access control. We discuss and suggest how challenges of legal and security aspects can be handled. This discussion may be useful for both current and future users, as well as policy makers.
... FEDERAL HOUSING FINANCE AGENCY [No. 2010-N-07] Privacy Act of 1974; System of Records AGENCY: Federal Housing Finance Agency. ACTION: Notice of the establishment of a new system of records. SUMMARY: The Federal Housing Finance Agency (FHFA) is revising the proposed system of records notice that was...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Security of systems of records. 700.24... Records Under the Privacy Act of 1974 § 700.24 Security of systems of records. (a) The Office Administrator or Security Officer shall be responsible for issuing regulations governing the security of systems...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Security of systems of records....33 Security of systems of records. (a) Each Program/Support Office Head or designee shall establish administrative and physical controls to prevent unauthorized access to its systems of records, to prevent...
... Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD PRIVACY ACT § 1705.03 Systems of records notification. (a) Public notice. The Board has published in the Federal Register its systems of records. The Office of the Federal Register biennially compiles and publishes all systems of records maintained by all Federal...
... Defense Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to alter a System of Records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records...
... Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Finance and Accounting Service is amending a system of records...
... Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend two Systems of Records. SUMMARY: The Defense Finance and Accounting Service is amending two systems of records...
... Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Finance and Accounting Service is amending a system of records...
..., Defense Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Finance and Accounting Service is amending a system of records...
...; System of Records AGENCY: Missile Defense Agency, Department of Defense (DoD). ACTION: Notice to Delete a System of Records. SUMMARY: The Missile Defense Agency proposes to delete a system of records notice in.... Peter Shearston, Missile Defense Agency, MDA/DXCM, 730 Irwin Ave, Schriever AFB, CO 80912-2101, or by...
...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Finance and Accounting Service is amending a system of records...: Mr. Gregory Outlaw, (317) 510-4591. SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting...
....regulations.gov . Follow the instructions for submitting comments. Mail: Federal Docket Management System... CFSC System name: Army Club Membership Files (June 21, 2001, 66 FR 33239). Reason: The records were..., Army Club Membership Files system of records notice can be deleted. Records have met the required...
Fletcher, Chadwick B
.... 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...
... Records: 500.050 HSPD-12: Identity Management System is being established to support implementation of...: USPS 500.050 SYSTEM NAME: HSPD-12: Identity Management System (IDMS). Accordingly, the Postal Service... Management System (IDMS). SYSTEM LOCATION: Records relating to the Identity Management System are maintained...
Matsuoka, Shingo; Yonezawa, Yoshiharu; Maki, Hiromichi; Ogawa, Hidekuni; Hahn, Allen W; Thayer, Julian F; Caldwell, W Morton
A new daily living activity recording system has been developed for monitoring health conditions and living patterns, such as respiration, posture, activity/rest ratios and general activity level. The system employs a piezoelectric sensor, a dual axis accelerometer, two low-power active filters, a low-power 8-bit single chip microcomputer and a 128 MB compact flash memory. The piezoelectric sensor, whose electrical polarization voltage is produced by mechanical strain, detects body movements. Its high-frequency output components reflect body movements produced by walking and running activities, while the low frequency components are mainly respiratory. The dual axis accelerometer detects, from body X and Y tilt angles, whether the patient is standing, sitting or lying down (prone, supine, left side or right side). The detected respiratory, behavior and posture signals are stored by the compact flash memory. After recording, these data are downloaded to a desktop computer and analyzed.
Full Text Available The aim of this research project was to evaluate the recordkeeping of postoperative nursing care. A total of 186 randomly selected patient records were evaluated in terms of a checklist that included the most important parameters for postoperative nursing care. All the patients underwent operations under general anaesthetic in one month in a Level 3 hospital and were transferred to general wards after the operations. The data collected was analysed by means of frequencies. One finding was that the neurological status of most patients was assessed but that little attention was paid in the patient records to emotional status and physical comfort. The respiratory and circulatory status of the patients and their fluid balance were inadequately recorded. The patients were well monitored for signs of external haemorrhage, but in most cases haemorrhage was checked only once, on return from the theatre. Although the patients’ pain experience were well-monitored, follow-up actions after the administration of pharmacological agents was poor. The surgical intervention was fully described and, generally speaking, the records were complete and legible, but the signatures and ranks of the nurses were illegible. Allergies were indicated in the most important records. The researchers recommend that a comprehensive and easily usable documentation form be used in postoperative nursing care. Such a form would serve as a checklist and could ensure to a large degree that attention is given to the most important postoperative parameters. Errors and negligence could also be reduced by this means.
Mc Quaid, Louise
Examination of electronic patient record (EPR) implementation at the socio-technical interface. This study was based on the introduction of an anti-epileptic drug (AED) management module of an EPR in an epilepsy out-patient clinic. The objective was to introduce the module to a live clinical setting within strictly controlled conditions to evaluate its usability and usefulness.
... the Privacy Act of 1974, 5 U.S.C. 552a, to publish a description of the systems of records containing... locked file cabinets, and electronic records are maintained on a password-protected desktop personal...'' published by the National Archives and Records Administration, Washington, DC. Paper records are shredded...
... follows: SEC-66 SYSTEM NAME: Backup Care Employee and Family Records. SYSTEM LOCATION: Bright Horizons... Securities Rulemaking Board; the Securities Investor Protection Corporation; the Public Company Accounting...
Thomas, Cecilia Engel; Jensen, Peter Bjødstrup; Werge, Thomas
Electronic patient records are a potentially rich data source for knowledge extraction in biomedical research. Here we present a method based on the ICD10 system for text-mining of Danish health records. We have evaluated how adding functionalities to a baseline text-mining tool affected...
...; System of Records AGENCY: United States Marine Corps, DoD. ACTION: Notice to delete twenty-three Systems... Management Information System Records, NM01560-2 Department of Defense Voluntary Education System, and...; NM01560-2 Department of Defense Voluntary Education System, and NM01500-2 Department of the Navy Education...
... 6 Domestic Security 1 2010-01-01 2010-01-01 false Security of systems of records. 5.31 Section 5.31 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY DISCLOSURE OF RECORDS AND INFORMATION Privacy Act § 5.31 Security of systems of records. (a) In general. Each component...
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.
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.
... manager. Record source categories: Individual, social workers, rehabilitation counselors, and/or health... mental impairments and applicants for employment with Washington Headquarters Services/Human Resources... of records in the system: Storage: Paper file folders and electronic storage media. Retrievability...
... Register Liaison Officer, Department of Defense. GNSA 01 System name: NSA/CSS Access, Authority and Release... records are covered by GNSA 11, NSA/CSS Key Accountability Records, GNSA 10, NSA/CSS Personnel Security...
RECORDING SYSTEMSA BriefHistory of Magnetic Storage, Dean PalmerPhysics of Longitudinal and Perpendicular Recording, Hong Zhou, Tom Roscamp, Roy Gustafson, Eric Boernern, and Roy ChantrellThe Physics of Optical Recording, William A. Challener and Terry W. McDanielHead Design Techniques for Recording Devices, Robert E. RottmayerCOMMUNICATION AND INFORMATION THEORY OF MAGNETIC RECORDING CHANNELSModeling the Recording Channel, Jaekyun MoonSignal and Noise Generation for Magnetic Recording Channel Simulations, Xueshi Yang and Erozan M. KurtasStatistical Analysis of Digital Signals and Systems, Dra
Woods, Susan S; Schwartz, Erin; Tuepker, Anais; Press, Nancy A; Nazi, Kim M; Turvey, Carolyn L; Nichol, W Paul
Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. A qualitative study with purposeful sampling sought to examine patients' views and experiences with reading their health records, including their clinical notes, online. Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared
... Integrated Results and Statistical Tracking.'' System Location: Delete entry and replace with ``Headquarters... replace with ``Records are accessed by person(s) responsible for servicing the record system in... need-to-know. The system additionally incorporates integrated system security features to protect data...
... DEPARTMENT OF EDUCATION Privacy Act of 1974; System of Records AGENCY: Office of Management...-19176 (April 12, 2004). Electronic Access to This Document: The official version of this document is the... Assistant Secretary of the Office of Management deletes the following system of records: System No. System...
...: The Department of the Army proposes to add a system of records to its inventory of record systems... provides a student management system that integrates Web-enabled courseware to support online certification... DEPARTMENT OF DEFENSE Department of the Army [Docket ID USA-2011-0019] Privacy Act of 1974; System...
...; Systems of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to alter a system of records. SUMMARY: The Defense Finance and Accounting Service (DFAS) is proposing to alter a system...) 522-5225. SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting Service notices for systems of...
... computer password protection.'' * * * * * System manager(s) and address: Delete entry and replace with...; Systems of Records AGENCY: National Security Agency/Central Security Service, DoD. ACTION: Notice to amend a system of records. SUMMARY: The National Security Agency (NSA) is proposing to amend a system of...
... Defense. GNSA 11 System name: NSA/CSS Key Accountability Records System location: National Security Agency... system: NSA/CSS civilian employees, personnel under contract or appointment and military assignees... `Blanket Routine Uses' set forth at the beginning of the NSA/CSS' compilation of systems of records notices...
Yu, Fei; Bilberg, Arne; Dalgas, Ulrik
FAMOS indicate that fatigued MS patients have reduced standard deviation (SD) of the heart rate (HR) during the short-term memory test, reduced high frequency (HF) component power spectrum (representing parasympathetic activation) at rest after walk test, and higher ratio of low frequency (LF) to HF (LF...
Winkelman, Warren J.; Leonard, Kevin J.
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 ...
Edinger, Tracy; Cohen, Aaron M; Bedrick, Steven; Ambert, Kyle; Hersh, William
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.
Langabeer, James R; Walji, Muhammad F; Taylor, David; Valenza, John A
The implementation of an electronic patient record (EPR) in many sectors of health care has been suggested to have positive relationships with both quality of care and improved pedagogy, although evaluation of actual results has been somewhat disillusioning. Evidence-based dentistry clearly suggests the need for tools and systems to improve care, and an EPR is a critical tool that has been widely proposed in recent years. In dental schools, EPR systems are increasingly being adopted, despite obstacles such as high costs, time constraints necessary for process workflow change, and overall project complexity. The increasing movement towards cost-effectiveness analyses in health and medicine suggests that the EPR should generally cover expenses, or produce total benefits greater than its combined costs, to ensure that resources are being utilized efficiently. To test the underlying economics of an EPR, we utilized a pre-post research design with a probability-based economic simulation model to analyze changes in performance and costs in one dental school. Our findings suggest that the economics are positive, but only when student fees are treated as an incremental revenue source. In addition, other performance indicators appeared to have significant changes, although most were not comprehensively measured pre-implementation, making it difficult to truly understand the performance differential-such pre-measurement of expected benefits is a key lesson learned. This article also provides recommendations for dental clinics and universities that are about to embark on this endeavor.
Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette
different departments: Orthopedics, Urology, Internal Medicine and Pediatrics. A total of 5,460 patients will be included from the outpatient clinics. All patients randomized to an intervention group are offered audio recording of their consultation. An Interactive Voice Response platform enables an audio....... The intervention will be evaluated using a questionnaire measuring different aspect of patients recall and understanding of the information given, patients need for additional information subsequent to the consultation and their overall satisfaction with the consultation. Results The study will be conducted from...
Caine, Kelly; Hanania, Rima
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.
Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S
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.
Krämer, T; Rapp, R; Krämer, K-L
The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the neccessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occured during this process.
Krämer, T; Rapp, R; Krämer, K L
The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the necessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occurred during this process.
Khunlertkit, Adjhaporn; Dorissaint, Leonard; Chen, Allen; Paine, Lori; Pronovost, Peter J
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.
Linnarsson, R; Nordgren, K
1. INTRODUCTION. A computer-based patient record (CPR) system, Swedestar, has been developed for use in primary health care. The principal aim of the system is to support continuous quality improvement through improved information handling, improved decision-making, and improved procedures for quality assurance. The Swedestar system has evolved during a ten-year period beginning in 1984. 2. SYSTEM DESIGN. The design philosophy is based on the following key factors: a shared, problem-oriented patient record; structured data entry based on an extensive controlled vocabulary; advanced search and query functions, where the query language has the most important role; integrated decision support for drug prescribing and care protocols and guidelines; integrated procedures for quality assurance. 3. A SHARED PROBLEM-ORIENTED PATIENT RECORD. The core of the CPR system is the problem-oriented patient record. All problems of one patient, recorded by different members of the care team, are displayed on the problem list. Starting from this list, a problem follow-up can be made, one problem at a time or for several problems simultaneously. Thus, it is possible to get an integrated view, across provider categories, of those problems of one patient that belong together. This shared problem-oriented patient record provides an important basis for the primary care team work. 4. INTEGRATED DECISION SUPPORT. The decision support of the system includes a drug prescribing module and a care protocol module. The drug prescribing module is integrated with the patient records and includes an on-line check of the patient's medication list for potential interactions and data-driven reminders concerning major drug problems. Care protocols have been developed for the most common chronic diseases, such as asthma, diabetes, and hypertension. The patient records can be automatically checked according to the care protocols. 5. PRACTICAL EXPERIENCE. The Swedestar system has been implemented in a
Paans, Wolter; Sermeus, Walter; Nieweg, Roos; van der Schans, Cees
AIM: This paper is a report of a study conducted to describe the accuracy of nursing documentation in patient records in hospitals. Background. Accurate nursing documentation enables nurses to systematically review the nursing process and to evaluate the quality of care. Assessing nurses' reports
Jaspers, M. W. M.; Knaup, P.; Schmidt, D.
OBJECTIVES: To provide an overview of trends in research, developments and implementations of the computerized patient record (CPR) of the last two years. METHODS: We surveyed the medical informatics literature, spanning the years 2004-2005, focusing on publications on CPRs. RESULTS: The main trends
The scanner of an encoded record support operates by the reflection principle. The record support has tracks brocken down into individual fields which are assigned light-dark markers for encoding purposes.The support consists of a light, non-transparent card which can be pulled over a slot by a guide attached to the scanner. The slot is arranged at an oblique angle relative to the card and emits radiation, for instance, light. This radiation is reflected by the tracks, the empty fields reflecting more radiation than the blackend ones, and then after having been transformed into signals, impinges upon phototransistors through openings. The number of openings corresponds to the number of tracks. The light can be made diffuse prior to exposure of the card by means of a red transparent plastic foil. (DG/RF) [de
... in the system: Storage: Delete entry and replace with ``Paper records maintained in file folders, binders, and electronic storage media.'' Retrievability: Delete entry and replace with ``Name, SSN and/or... Personnel Record Group for permanent retention. Paper records are destroyed after electronic copy has been...
... Defense. NM05720-1 System name: FOIA Request/Appeal Files and Tracking System (April 2, 2008, 73 FR 17961...: Delete entry and replace with ``Records are accessed by custodian of the record system and by persons... cabinets or rooms, which are not viewable by individuals who do not have a need to know. Computerized...
... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Security of systems of records. 792.67 Section... AND PRIVACY ACT, AND BY SUBPOENA; SECURITY PROCEDURES FOR CLASSIFIED INFORMATION The Privacy Act § 792.67 Security of systems of records. (a) Each system manager, with the approval of the head of that...
... separate systems of records: ``FHFA-OIG Audit Files Database,'' ``FHFA-OIG Investigative & Evaluative Files...-OIG-1 system name: FHFA-OIG Audit Files Database. security classification: Sensitive but unclassified.... categories of records in the system: (1) Audit reports; and (2) working papers, which may include copies of...
.... This system of records maintains information related to recordation of assignments of property rights.... Categories of individuals covered by the system: Persons who have given or received property rights under an... system: Assignments, grants, mortgages, liens, encumbrances, licenses, and other instruments affecting...
... anticipated threats or hazards to the security or integrity of data, which could result in substantial harm... 32 National Defense 3 2010-07-01 2010-07-01 true Privacy Act systems of records. 505.3 Section 505... AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM § 505.3 Privacy Act systems of records. (a) Systems of...
.... For a list of system managers at the Defense Logistics Agency Primary Level Field Activities write to... managers at the Defense Logistics Agency Primary Level Field Activities, write to the Project Manager...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to amend a system of records...
... DEPARTMENT OF EDUCATION Privacy Act of 1974; System of Records AGENCY: Office of English Language Acquisition, Language Enhancement and Academic Achievement for Limited English Proficient Students, Department... Secretary of the Office of English Language Acquisition deletes the following system of records: System...
... media. Retrievability: Records are retrieved in the system by name, Social Security Number (SSN), NGA.... DATES: The system will be effective on February 24, 2010, unless comments are received that would result..., or badge to an NGA facility. Categories of records in the system: Names, Social Security Number (SSN...
... terrorism and national security threat screening, system back-up, and continuity of operations purposes... DEPARTMENT OF JUSTICE [CPCLO Order No. 004-2011] Privacy Act of 1974; System of Records AGENCY: Federal Bureau of Investigation, Department of Justice. ACTION: Notice to amend system of records. SUMMARY...
..., Corporate Communications, Defense Finance and Accounting Service, DFAS-HKC/IN, 8899 E. 56th Avenue...; System of Records AGENCY: Defense Finance and Accounting Service; DoD. ACTION: Notice to add a system of records. SUMMARY: The Defense Finance and Accounting Service (DFAS) is proposing to add a system of...
Pagliari, Claudia; Shand, Tim; Fisher, Brian
To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Primary care centres within NHS England that had offered online record access for the preceding year. Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients' health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.
Pratt, Thomas L.
The goal of this project was to use off-the-shelf music recording equipment to build and test a prototype seismic system to listen for people trapped in underground chambers (mines, caves, collapsed buildings). Previous workers found that an array of geophones is effective in locating trapped miners; displaying the data graphically, as well as playing it back into an audio device (headphones) at high speeds, was found to be effective for locating underground tapping. The desired system should record the data digitally to allow for further analysis, be capable of displaying the data graphically, allow for rudimentary analysis (bandpass filter, deconvolution), and allow the user to listen to the data at varying speeds. Although existing seismic reflection systems are adequate to record, display and analyze the data, they are relatively expensive and difficult to use and do not have an audio playback option. This makes it difficult for individual mines to have a system waiting on the shelf for an emergency. In contrast, music recording systems, like the one I used to construct the prototype system, can be purchased for about 20 percent of the cost of a seismic reflection system and are designed to be much easier to use. The prototype system makes use of an ~$3,000, 16-channel music recording system made by Presonus, Inc., of Baton Rouge, Louisiana. Other manufacturers make competitive systems that would serve equally well. Connecting the geophones to the recording system required the only custom part of this system - a connector that takes the output from the geophone cable and breaks it into 16 microphone inputs to be connected to the music recording system. The connector took about 1 day of technician time to build, using about $300 in off-the-shelf parts. Comparisons of the music recording system and a standard seismic reflection system (A 24-channel 'Geode' system manufactured by Geometrics, Inc., of San Jose, California) were carried out at two locations. Initial
... accounting shall be made, in accordance with paragraph (e) of this section, of any disclosure under paragraph (a) of this section of a record that is not a disclosure under § 21.70. (e) Where an accounting is... of the disclosure. The accounting shall not be considered a Privacy Act Record System. (2) Retain the...
Karanjia, Rustum; Brunet, Donald G; ten Hove, Martin W
To explore the influence of environmental conditions on pattern visual evoked potential (VEP) recordings. Fourteen subjects with no known ocular pathology were recruited for the study. In an attempt to optimize the recording conditions, VEP recordings were performed in both the seated and recumbent positions. Comparisons were made between recordings using either LCD or CRT displays and recordings obtained in silence or with quiet background music. Paired recordings (in which only one variable was changed) were analyzed for changes in P100 latency, RMS noise, and variability. Baseline RMS noise demonstrated a significant decrease in the variability during the first 50msec accompanied by a 73% decrease in recording time for recumbent position when compared to the seated position (pmusic did not affect the amount of RMS noise during the first 50msec of the recordings. This study demonstrates that the use of the recumbent position increases patient comfort and improves the signal to noise ratio. In contrast, the addition of background music to relax the patient did not improve the recording signal. Furthermore, the study illustrates the importance of avoiding low-contrast visual stimulation patterns obtained with LCD as they lead to higher latencies resulting in false positive recordings. These findings are important when establishing or modifying a pattern VEP recording protocol.
Xue, Zhao; Hu, Liangshuo; Tang, Bo; Zhang, Xiaogang; Lyu, Yi
To develop a diagrammatic recording system for choledochoscopy and evaluate the system with clinical application. To match the real-time image and procedure illustration during choledochoscopy examination, we combined video-image capture and speech recognition technology to quickly generate personalized choledochoscopy images and texts records. The new system could be used in sharing territorial electronic medical records, telecommuting, scientific research and education, et al. In the clinical application of 32 patients, the choledochoscopy diagrammatic recording system could significantly improve the surgeons' working efficiency and patients' satisfaction. It could also meet the design requirement of remote information interaction. The choledochoscopy diagrammatic recording system which is recommended could elevate the quality of medical service and promote academic exchange and training.
Ragneskog, H; Asplund, K; Kihlgren, M; Norberg, A
Many nursing home patients with dementia suffer from symptoms of agitation (e.g. anxiety, shouting, irritability). This study investigated whether individualized music could be used as a nursing intervention to reduce such symptoms in four patients with severe dementia. The patients were video-recorded during four sessions in four periods, including a control period without music, two periods where individualized music was played, and one period where classical music was played. The recordings were analysed by systematic observations and the Facial Action Coding System. Two patients became calmer during some of the individualized music sessions; one patient remained sitting in her armchair longer, and the other patient stopped shouting. For the two patients who were most affected by dementia, the noticeable effect of music was minimal. If the nursing staff succeed in discovering the music preferences of an individual, individualized music may be an effective nursing intervention to mitigate anxiety and agitation for some patients.
Dudding, Katherine M; Gephart, Sheila M; Carrington, Jane M
In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.
.../COPS-002 SYSTEM NAME: COPS Online Ordering System. SECURITY CLASSIFICATION: Unclassified. SYSTEM... to economic or property interests, identity theft or fraud, or harm to the security or integrity of... system of records entitled, ``COPS Online Ordering System,'' (JUSTICE/COPS-002). The system collects...
Guo Tianrui; Du Yifei
In the data acquisition system supported by the microcomputer tape recorder, as the acquisition speed is often limited by the low speed of tape recorder, so a double tape recorder system is designed. In this system, two tape recorders are used in on-line acquisition system simultaneously. One DMA channel used is one designed for soft disk driver, another DMA channel used is one retained for user. By this way, the speed of tape writing could be increased to nearly twice as much. In order to prevent the data confusion, the authors open two data buffers in system and write different mark in each buffer, then write the data block to two tape recorders according to the mark. The system complies with the principle: 'Double write, Double read'
Roque, Francisco S.; Jensen, Peter B.; Schmock, Henriette
Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracting...... phenotype information from the free-text in such records we demonstrate that we can extend the information contained in the structured record data, and use it for producing fine-grained patient stratification and disease co-occurrence statistics. The approach uses a dictionary based on the International...
Megan Forster, Megan; Dennison, Kerrie; Callen, Joanne; Andrew, Andrew; Westbrook, Johanna I
Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response
Genn, B; Geukers, L
In order to achieve real benefit from the potential offered by a Computer-Based Patient Record, the capabilities of the technology must be applied along with true re-engineering of healthcare delivery processes. University Hospital recognizes this and is using systems implementation projects, such as the catalyst, for transforming the way we care for our patients. Integration is fundamental to the success of these initiatives and this must be explicitly planned against an organized systems architecture whose standards are market-driven. University Hospital also recognizes that Community Health Information Networks will offer improved quality of patient care at a reduced overall cost to the system. All of these implementation factors are considered up front as the hospital makes its initial decisions on to how to computerize its patient records. This improves our chances for success and will provide a consistent vision to guide the hospital's development of new and better patient care.
... aircraft. Categories of records in the system: Name, last four of Social Security Number (SSN), squadron ID... of Appendix I to OMB Circular No. A-130, ``Federal Agency Responsibilities for Maintaining records... Military Flight Operations Quality Assurance System location: Primary databases (Enterprise Level Servers...
... DEPARTMENT OF EDUCATION Privacy Act of 1974; System of Records AGENCY: Federal Student Aid, Department of Education. ACTION: Notice of an altered system of records. SUMMARY: In accordance with the Privacy Act of 1974, as amended (Privacy Act), 5 United States Code (U.S.C.) 552a, the Chief Operating...
... contacted in order to obtain that office's advice regarding obligations under the Privacy Act; 8. Breach... FEDERAL COMMUNICATIONS COMMISSION Privacy Act System of Records AGENCY: Federal Communications Commission. ACTION: Notice; one new Privacy Act system of records. SUMMARY: Pursuant to subsection (e)(4) of...
With, de P.H.N.; Breeuwer, M.; van Grinsven, P.A.M.
The authors focus on image data compression techniques for digital recording. Image coding for storage equipment covers a large variety of systems because the applications differ considerably in nature. Video coding systems suitable for digital TV and HDTV recording and digital electronic still
...: Individuals who are consultants and vendors to PBGC. Categories of records in the systems: Payment vouchers..., Human Resources Department; Director, Benefits Administration and Payment Department. Correspondence... system of records is maintained for use in determining amounts to be paid and in effecting payments by...
... ``Program Manager, Law Enforcement Operations, Headquarters, Defense Logistics Agency, Office of Public... Manager, Law Enforcement Operations, Headquarters, Defense Logistics Agency, Office of Public Safety, 8725...; Systems of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to amend a system of records...
... FEDERAL DEPOSIT INSURANCE CORPORATION Privacy Act of 1974; System of Records AGENCY: Federal Deposit Insurance Corporation. ACTION: Notice to Delete a System of Records. SUMMARY: In accordance with the requirements of the Privacy Act of 1974, as amended (Privacy Act), the Federal Deposit Insurance...
... Defense Finance and Accounting Service proposes to alter a system of records, T7205, General Accounting... transaction-driven financial statements in support of Defense Finance and Accounting Service financial mission... INFORMATION: The Defense Finance and Accounting Service notices for systems of records subject to the Privacy...
... Records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records in its... information. FOR FURTHER INFORMATION CONTACT: Mr. Gregory L. Outlaw, Defense Finance and Accounting Service... name: General Accounting and Finance System--Defense Transaction Interface Module (June 4, 2007, 72 FR...
Win, Khin Than; Susilo, Willy; Mu, Yi
The objective of this study is to analyze the security protection of personal health record systems. To achieve this we have investigated different personal health record systems, their security functions, and security issues. We have noted that current security mechanisms are not adequate and we have proposed some security mechanisms to tackle these problems.
... SMALL BUSINESS ADMINISTRATION Privacy Act System of Records AGENCY: Small Business Administration. ACTION: Notice of new Privacy Act system of records and request for comment. SUMMARY: The Small Business... the protected information collected from applicants and participants in the Small Business Innovation...
Klein Gunnar O
Full Text Available Abstract Background EHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. Our objective was to provide a more flexible solution enabling the clinicians to define which data to be recorded and shared for both routine documentation and clinical studies. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data. Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems. Methods We have designed and developed a template based system (called Julius that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely web-based, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database. Results The Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems. Conclusion The approach of the template system in combination with various local EHR
Riley, Jeffrey B; Justison, George A
The authors comment on Steffens and Gunser's article describing the University of Wisconsin adoption of the Epic anesthesia record to include perfusion information from the cardiopulmonary bypass patient experience. We highlight the current-day lessons and the valuable quality and safety principles the Wisconsin-Epic model anesthesia-perfusion record provides.
Harold F. Haupt; Bud L. Jeffers
Describes an accurate and simple system for taking continuous weight records of sapling-size trees. Measurements obtained using this system have helped in describing the mechanism of interception storage in tree crowns during snowfall.
.... Mail: Federal Docket Management System Office, 4800 Mark Center Drive, East Tower, 2nd Floor, Suite..., payroll office and payroll records, including automated payroll systems.'' * * * * * [FR Doc. 2012-3720...
... National Instant Criminal Background Check System § 25.6 Accessing records in the system. (a) FFLs may... through the NCIC communication network. Upon receiving a request for a background check from an FFL, a POC...
Automated Records Management Systems in the ESARBICA Region. ... to organizations as human and financial resources and that their management is important. ... Latter day archivists work with other professionals such as auditors, systems ...
... by the transferring medical facility which includes, patient identity, service affiliation and grade or status, name, Social Security Number (SSN), gender, medical diagnosis, medical condition, special...: Delete entry and replace with ``Paper records in file folders and electronic storage media...
Oborn, Eivor; Barrett, Michael; Davidson, Elizabeth
In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this persp...
... in this system can range from UNCLASSIFIED to TOP SECRET. SYSTEM LOCATION: Office of the Director of... UNCLASSIFIED to TOP SECRET. SYSTEM LOCATION: Office of the Director of National Intelligence, Washington, DC... classification of records in this system can range from UNCLASSIFIED to TOP SECRET. SYSTEM LOCATION: Office of...
... Technology E-Learning System (December 8, 2008, 73 FR 74471). * * * * * CHANGES: SYSTEM ID: Delete entry and replace with ``F033 AFSPC C''. SYSTEM NAME: Delete entry and replace with ``AF e-Learning System.'' SYSTEM... OMB Circular No. A-130, ``Federal Agency Responsibilities for Maintaining Records About Individuals...
Callahan, Ryan; Sevdalis, Nick; Mayer, Erik K; Darzi, Ara
Background Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than
Miotto, Riccardo; Li, Li; Kidd, Brian A.; Dudley, Joel T.
Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems.
Full Text Available on literature and confirmed in this case study, if adoption of EMR systems is the ultimate goal, the implementation thereof should be properly managed with strong leadership and political backing at the highest level. Adoption is also supported by keeping...
Fukuda, Toshiyuki; Tanaka, Shoji; Fujiwara, Shinji; Onozuka, Kuniharu
A feasibility study of video tape recorder (VTR) modification to add the capability of data recording etc. was conducted. This system is an on-broad system to support Spacelab experiments as a dedicated video system and a dedicated data recording system to operate independently of the normal operation of the Orbiter, Spacelab and the other experiments. It continuously records the video image signals with the acquired data, status and operator's voice at the same time on one cassette video tape. Such things, the crews' actions, animals' behavior, microscopic views and melting materials in furnace, etc. are recorded. So, it is expected that experimenters can make a very easy and convenient analysis of the synchronized video, voice and data signals in their post flight analysis.
Winkelman, Warren J; Leonard, Kevin J
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.
Ahmadi, Maryam; Ghazisaeidi, Marjan; Bashiri, Azadeh
In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. This study provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with the electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. This is a cross-sectional study that was conducted in 2013. The study population was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also Visual Paradigm software was used to design a conceptual model. Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, with providing the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.
Czech, Z.; Turek, L.; Wierzewski, K.
A digital system for automatic control and data recording being a part of a neutron diffractometer designed for measurement of the angular distribution of monochromatic neutrons is described. The system is built using digital TTL integrated circuits. Particular attention is drawn to the interesting design of the optimized cross-matrix which selects the elements subjected to recording. The system successfully works with the neutron diffractometer at the EWA reactor. (author)
Harle, Christopher A; Listhaus, Alyson; Covarrubias, Constanza M; Schmidt, Siegfried Of; Mackey, Sean; Carek, Peter J; Fillingim, Roger B; Hurley, Robert W
In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Beltrán-Aguilar, Eugenio D; Eke, Paul I; Thornton-Evans, Gina
This paper describes tools used to measure periodontal diseases and the integration of these tools into surveillance systems. Tools to measure periodontal diseases at the surveillance level have focussed on current manifestations of disease (e.g. gingival inflammation) or disease sequelae (e.......g. periodontal pocket depth or loss of attachment). All tools reviewed in this paper were developed based on the state of the science of the pathophysiology of periodontal disease at the time of their design and the need to provide valid and reliable measurements of the presence and severity of periodontal...... diseases. Therefore, some of these tools are no longer valid. Others, such as loss of periodontal attachment, are the current de-facto tools but demand many resources to undertake periodical assessment of the periodontal health of populations. Less complex tools such as the Community Periodontal Index...
... Administration (VBA). This system is a core system for VBA programs. This system of records does not directly... processing system designed to serve as the cornerstone of VBA's transition to paperless claims processing... attorney and any information concerning such individual which is relevant to a refusal to grant access...
... 0450 System name: Drug-Free Workplace Files (September 9, 2009, 74 FR 46418). Changes: * * * * * System... employment with the Defense Intelligence Agency.'' Categories of records in the system: Delete entry and... of the system: Delete entry and replace with ``E.O. 12564, Federal Drug Free Workplace; DoD Directive...
... THE SYSTEM: STORAGE: Paper records and on electronic storage media. RETRIEVABILITY: Name and/or Social... Institute of Technology Management and Information System (AFITMIS) (February 21, 2008, 73 FR 9548). CHANGES: * * * * * SYSTEM NAME: Delete entry and replace with ``Air Force Institute of Technology Student Information System...
..., ``Federal Agency Responsibilities for Maintaining Records About Individuals,'' dated February 8, 1996... system: Delete entry and replace with ``Records contain individual's name, Social Security Number (SSN....C. 8032, The Air Staff: general duties; Air Force Instruction 36-2102, Base-Level Relocation...
... name, address, phone number, birth date, and Social Security Number (SSN).'' Authority for maintenance... storage media.'' * * * * * System manager(s) and address: Delete entry and replace with ``Chief of... signature as a means of proving the identity of the individual requesting access to the records.'' Record...
... related to disciplinary actions, responses from subjects, and correspondence with Governmental agencies... responsibility and mismanagement; to take adverse action and appropriate disciplinary action against those found... of Records AGENCY: Department of the Army, DoD. ACTION: Notice to Amend a System of Records. SUMMARY...
... Responsibility Committee opinions, memoranda related to disciplinary actions, responses from subjects, and... professional responsibility and mismanagement; to take adverse action and appropriate disciplinary action... of Records AGENCY: Department of the Army, DoD. ACTION: Notice to amend a system of records. SUMMARY...
...;and investigations, committee meetings, agency decisions and rulings, #0;delegations of authority..., the United States Agency for International Development (USAID) is deleting the AID-15 Employee Payroll..., USAID is deleting the AID-15 Employee Payroll Records system of records because it is now covered under...
..., ``Federal Agency Responsibilities for Maintaining Records About Individuals,'' dated February 8, 1996... United States civilian personnel who are recommended for an award.'' Categories of Records in the System... Command (MAJCOM) are destroyed after 50 years. Decorations to individuals (Military and Civilian...
..., official title, subproject code, work address, home address, work phone, home phone, Social Security Number... system: Storage: Paper records and electronic storage media. Retrievability: Records may be retrieved by... duties and who have appropriate clearances and permissions. Usage of physical access controls, encryption...
... online tool helps the staff members at all four levels (school, district, area, and headquarters) apply... to paragraph 4c of Appendix I to OMB Circular No. A-130, ``Federal Agency Responsibilities for.... Categories of records in the system: Records consist of first name, last name, Social Security Number (SSN...
....'' * * * * * Storage: Delete entry and replace with ``Maintained on electronic storage media and/or in file binders... individual for consideration of continued service in the Air Force. Paper records are destroyed by tearing... records in the system: Storage: Maintained on electronic storage media and/or in file binders/ cabinets...
... records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records in its.... FOR FURTHER INFORMATION CONTACT: Mr. Gregory Outlaw, Defense Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate Communications, DFAS-HKC/IN, 8899 E. 56th...
... Records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records notice... information. FOR FURTHER INFORMATION CONTACT: Mr. Gregory L. Outlaw, Defense Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate Communications, DFAS-HKC/IN, 8899 E. 56th...
... Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate... Records. SUMMARY: The Defense Finance and Accounting Service proposes to amend a system of records in its.... FOR FURTHER INFORMATION CONTACT: Mr. Gregory L. Outlaw, Defense Finance and Accounting Service...
... Records. SUMMARY: The Defense Finance and Accounting Service proposes to amend a system of records in its... information. FOR FURTHER INFORMATION CONTACT: Mr. Gregory L. Outlaw, Defense Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate Communications, DFAS-HKC/IN, 8899 E. 56th...
... Records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records in its.... FOR FURTHER INFORMATION CONTACT: Mr. Gregory L. Outlaw, Defense Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate Communications, DFAS-HKC/IN, 8899 E. 56th...
... Management, the Office of Government Ethics, and the Department of Labor. Government-wide systems of records.../GOVT-1: Executive Branch Public Financial Disclosure Reports and Other Name-Retrieved Ethics Program... folders in locked file cabinets in Procurement and financial management staff offices. Electronic records...
... established as the Income Verification Match Center, has authority under section 8051 to verify Veterans' self...) is amending the system of records currently titled ``Income Verification Records--VA'' (89VA16) as... Reconciliation Act of 1990, provides VA the authority to verify Veterans' self-reported income to determine...
... identification and password or smart card technology protocols. Retention and disposal: Records are destroyed...: Records maintained include individual's name, home or business telephone number, e-mail and mailing..., Technology, and Logistics. Purpose(s): The system is used to produce subscription mailing lists for...
...; and E.O. 9397 (SSN), as amended.'' * * * * * RETENTION AND DISPOSAL: Delete entry and replace with ``Disposition is pending. Until the National Archives and Records Administration approve a retention and... limited access for job performance requirements. CATEGORIES OF RECORDS IN THE SYSTEM: Name, home address...
... records to COMMERCE/DEPARTMENT-20, Biographical Files and Social Networks. The amendment serves to modify... DEPARTMENT OF COMMERCE [Docket No. 130730666-3877-02] Privacy Act Altered System of Records AGENCY: Department of Commerce. ACTION: Notice; Commerce/Department-20, Biographical Files. SUMMARY: The Department...
... records, etc.) of employees and applicants for employment. Records contained in this system are also used.../Central Security Service (NSA/CSS) applicants for employment and employees tested for the use of illegal... Workplace; DoD Directive 1010.9, DoD Civilian Employee Drug Abuse Testing Program; and E.O. 9397 (SSN), as...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0140] Privacy Act of 1974... records notices in its existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C... submissions available for public viewing on the Internet at http://www.regulations.gov as they are received...
... Officer, Department of Defense. Deletion: S330.40 CAHS System name: Employee Assistance Program Records (August 27, 1999; 64 FR 46889). Reason: This collection is covered under the existing DHHS/FOH EAP Privacy notice 09-90-0010, entitled ``Employee Assistance Program (EAP) Records, HHS/OS/ASAM/OHR.'' [FR Doc. 2010...
..., rank/grade, Social Security Number (SSN), promotion photos, date of birth, blood type, hair and eye... birth, home of record, records of emergency data. Personnel/Duty Related Information: Enlistment... Manpower Data Center (DMDC); and Department of Agriculture (DoA). Exemptions claimed for the system: None...
... Organization Assessment Subcommittee (OASC) Chair(s), based on recommendation of a professional committee of... studies is therefore evaluated by a professional committee: the Data Use Agreement committee of the OASC..., ACCESSING, RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Records are maintained on the server...
Veer, A.J.E. de; Francke, A.L.
BACKGROUND: A growing number of health care organizations are implementing a system of electronic patient records (EPR). This implies a change in work routines for nursing staff, but it could also be regarded as an opportunity to improve the quality of care. OBJECTIVE: The objective of this paper is
Full Text Available Nir Menachemi¹, Taleah H Collum²¹Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA; ²Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: The Health Information Technology for Economic and Clinical Health (HITECH Act of 2009 that was signed into law as part of the "stimulus package" represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs. In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors, organizational outcomes (eg, financial and operational benefits, and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs. Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a “meaningful” way.Keywords: EHR, health information technology, HITECH, computerized order entry, health information exchange
... specialty within each career management field. Routine uses of records maintained in the system, including..., distribution and utilization of all personnel in military duties, strength accounting and manpower management...
... be deleted. A0210-130 DALO Laundry Accounting Files (April 12, 1999, 64 FR 17641). Reason: The... schedule; therefore, the system of records notice can be deleted. A0600-8-104g AHRC Career Management...
... under the Freedom of Information Act (FOIA) or the Privacy Act. Categories of records in the system: The... allegation or complaint of discrimination based on race, color, religion, sex, national origin, age, or...
.../GOVT-6 GSA SmartPay Purchase Charge Card Program; GSA/GOVT-8 Excluded Parties List System (EPLS); MSPB... Other Ethics Program Records; OGE/GOVT-2 Confidential Statements of Employment and Financial Interests...
... . Follow the instructions for submitting comments. Mail: Federal Docket Management System Office, 1160... of the Army, Privacy Office, U.S. Army Records Management and Declassification Agency, 7701 Telegraph...; laboratory reports, polygraph reports, documentary evidence, physical evidence, summary and administrative...
... and culture, learning ability, physical performance, combat readiness, discipline, motivation... education, work experience, motivation, knowledge of and attitude about the Army. When records show military... methods and systems aimed at improved group performance. (No decisions affecting an individual's rights or...
.... FOR FURTHER INFORMATION CONTACT: Mr. Leroy Jones, Department of the Army, Privacy Office, U.S. Army.../army/index.html . The Department of the Army proposes to amend two systems of records notices in its...
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 ...
... categories: Individual, social workers, rehabilitation counselors, and/or health care personnel. Exemptions... mental impairments and applicants for employment with Washington Headquarters Services/Human Resources... of records in the system: Storage: Paper files folders and electronic storage media. Retrievability...
Shenhav, N.J.; Leiferman, G.; Segal, Y.; Notea, A.
A system was developed to digitize and record the time intervals between detection event pulses, feed to its input channels from a detection device. The accumulated data is transferred continuously in real time to a disc through a PDP 11/34 minicomputer. Even though the system was designed for a specific scope, i.e., the comparative study of passive neutron nondestructive assay methods, it can be characterized by its features as a general purpose time series recorder. The time correlation analysis is performed by software after completion of the data accumulation. The digitizing clock period is selectable and any value, larger than a minimum of 100 ns, may be selected. Bursts of up to 128 events with a frequency up to 10 MHz may be recorded. With the present recorder-minicomputer combination, the maximal average recording frequency is 40 kHz. (orig.)
...: * * * * * System name: Delete entry and replace with ``DIA Military Recognition and Awards Files.'' System location... personnel recommended for recognition or awards while assigned or attached to DIA.'' Categories of records in the system: Delete entry and replace with ``Full name, rank, service affiliation, and Social...
... IN THE SYSTEM: Delete entry and replace with ``Identity information that includes Social Security... RECORDS IN THE SYSTEM: Identity information that includes Social Security Number (SSN), name, sex, race... SYSTEM: STORAGE: Delete entry and replace with ``Paper file folders and electronic storage media...
... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Safeguarding systems of... maintained. (b) Personnel information contained in both manual and automated systems of records shall be... alternative storage system providing that it furnished an equivalent degree of physical security as storage in...
...), interested persons are invited to submit written data, views, or arguments on this proposal. A report of the... Tracking Activity USPS 830.000 SYSTEM NAME: Customer Service and Correspondence USPS 840.000 SYSTEM NAME... waiting to know if information about them is kept in this system of records must address inquiries in...
... inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: The... Federal Register Liaison Officer, Department of Defense. N05000-1 System name: OPNAV Headquarters Web... DEPARTMENT OF DEFENSE Department of the Navy [Docket ID USN-2011-0015] Privacy Act of 1974; System...
..., Alternate OSD Federal Register Liaison Officer, Department of Defense. DHA 10 System name: DoD Women... records, please contact the system manager.'' Categories of individuals covered by the system: Delete... members who are eligible for the DoD Women, Infants, and Children Overseas Program.'' Categories of...
... Administration (R-ADM). System location: United States Navy ships and submarines. Official mailing addresses are... by the system: United States Navy commissioned and enlisted personnel. Categories of records in the system: Name, Social Security Number (SSN), gender, race/ethnicity, birth date, place of birth, home...
... other than military members.'' Safeguards: Delete entry and replace with ``Mass Communication Tool (MCT... System name: Marine Corps Family Readiness Mass Communication Records. System location: Primary location.... Safeguards: Mass Communication Tool (MCT)--Password controlled system, file, and element access based on...
Zhang Lingyun; Yang Xiaojun; Song Kezhu; Wang Yanfang
This paper introduces a multi-channel and high-speed time recorder system, which was originally designed to work in the experiments of quantum cryptography research. The novelty of the system is that all the hardware logic is performed by only one FPGA. The system can achieve several desirable features, such as simplicity, high resolution and high processing speed. (authors)
... Information Architecture--Learning Management System (ATIA-LMS).'' * * * * * Authority for maintenance of the...). (Signature)'.'' * * * * * A0351b TRADOC DoD System name: Army Training Information Architecture--Learning... (703) 428-6185. SUPPLEMENTARY INFORMATION: Department of the Army notices for systems of records...
... system of records has been sent to the U.S. Congress and the Office of Management and Budget (OMB). V... Classification: Unclassified, Sensitive. System Location: Medical Exemption Program databases reside at the..., encryption, firewalls, and secured operating systems and to which only authorized personnel with a specific...
... DEPARTMENT OF DEFENSE [Docket ID: USN-2013-0046] Privacy Act of 1974; System of Records AGENCY... Privacy Act of 1974, as amended. The system being deleted is N01500-8, System Name: Personnel and Training... Internet at http://www.regulations.gov as they are received without change, including any personal...
..., proposes to modify the Accounting Systems for the Department of Justice, Justice/DOJ-001, to update the... the system description is set forth below. FOR FURTHER INFORMATION CONTACT: Robin Moss, Privacy... NAME: Accounting Systems for the Department of Justice (DOJ). * * * * * RECORD SOURCE CATEGORIES...
... Program Manager, USDA, Forest Service, Office of Safety and Occupational and Health, 1400 Independence... Management Handbook (FSH) 6209.11. This system is abolished and removed from the inventory of the USDA System... DEPARTMENT OF AGRICULTURE Office of the Secretary Abolishment of Privacy Act System of Records...
... 10-0004 System name: Occupational, Safety, Health, and Environmental Management Records (July 2, 2010...: Delete entry and replace with ``This system will manage occupational, safety, health, and environmental... Management System Office, 4800 Mark Center Drive; East Tower, 2nd Floor, Suite 02G09, Alexandria, VA 22350...
... a System of Records. SUMMARY: The National Security Agency (NSA) is proposing to amend a system of..., Alternate OSD Federal Register Liaison Officer, Department of Defense. GNSA 25 System Name: NSA/CSS Travel... ``Primary location: National Security Agency/Central Security Service (NSA/CSS), 9800 Savage Road, Ft...
Chapman, L.J.; Hakimi, R.; Salehi, D.; McCord, T.; Zionczkowski, B.; Churchill, R.
This exhibit describes computer applications in monitoring patient tracking in radiology and the collection of management information (technologist productivity, patient waiting times, repeat rate, room utilization) and quality assurance information. An analysis of the reports that assist in determining staffing levels, training needs, and patient scheduling is presented. The system is designed to require minimal information input and maximal information output to assist radiologists, quality assurance coordinators, and management personnel in departmental operations
Krist Alex H
Full Text Available Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results
Braden, A.B.; McBride, T.R.; Styblo, D.J.; Taylor, S.K.; Richey, J.B.
A patient support system for use in computerized tomography (CT) is described. The system is particularly useful for CT scanning of the brain and also of the abdominal area. The support system consists of two moveable tables which may be translated into position for X-ray scanning of the patient's body and which may be translated incrementally and automatically to obtain scans at adjacent locations. For use with brain scans, the second table is replaced by a detachable restraint assembly which is described in detail. The support system is so designed that only a small volume of low density material will intercept the X-ray beam. (UK)
Herk-Sukel, Myrthe P P van; Lemmens, Valery E P P; Poll-Franse, Lonneke V van de; Herings, Ron M C; Coebergh, Jan Willem W
An increasing need has developed for the post-approval surveillance of (new) anti-cancer drugs by means of pharmacoepidemiology and outcomes research in the area of oncology. To create an overview that makes researchers aware of the available database linkages in Northern America and Europe which facilitate pharmacoepidemiology and outcomes research in cancer patients. In addition to our own database, i.e. the Eindhoven Cancer Registry (ECR) linked to the PHARMO Record Linkage System, we considered database linkages between a population-based cancer registry and an administrative healthcare database that at least contains information on drug use and offers a longitudinal perspective on healthcare utilization. Eligible database linkages were limited to those that had been used in multiple published articles in English language included in Pubmed. The HMO Cancer Research Network (CRN) in the US was excluded from this review, as an overview of the linked databases participating in the CRN is already provided elsewhere. Researchers who had worked with the data resources included in our review were contacted for additional information and verification of the data presented in the overview. The following database linkages were included: the Surveillance, Epidemiology, and End-Results-Medicare; cancer registry data linked to Medicaid; Canadian cancer registries linked to population-based drug databases; the Scottish cancer registry linked to the Tayside drug dispensing data; linked databases in the Nordic Countries of Europe: Norway, Sweden, Finland and Denmark; and the ECR-PHARMO linkage in the Netherlands. Descriptives of the included database linkages comprise population size, generalizability of the population, year of first data availability, contents of the cancer registry, contents of the administrative healthcare database, the possibility to select a cancer-free control cohort, and linkage to other healthcare databases. The linked databases offer a longitudinal
...: Electronic, hardcopy. RETRIEVABILITY: By individual name. SAFEGUARDS: All users are given cyber security...: Purpose and Disclosure to Consumer Reporting Agencies. Any persons interested in commenting on the amended.... State-22 SYSTEM NAME: Records of the Bureau of Public Affairs. SECURITY CLASSIFICATION: Unclassified...
..., protect the environment, and enhance the marketing of agricultural products. The system of records covers... marketing data; Lease and transfer of allotments and quotas; Appeals; New grower applications; Conservation... boundaries and is recommended as the common location identifier for reporting acreage. Digital renditions of...
Krakov, A; Kabaha, N; Azuri, J; Moshe, S
Information technologies offer new ways to engage with patients regarding their health, but no studies have been done in occupational health services (OHS). To examine the advantages and disadvantages of providing written and oral medical information to patients in OHS. In this cross-sectional study, data were retrieved from patients visiting four different OHS during 2014-15 for a fitness for work evaluation. We built a semi-quantitative satisfaction questionnaire, with responses ranging on a Likert scale of 1-5 from very dissatisfied (1) to very satisfied (5). There were 287 questionnaires available for analysis. The number of patients who received detailed oral and written information, which included an explanation of their health condition and of the occupational physician's (OP's) decision, was higher in clinics 1 and 3 compared to clinics 2 and 4 (48 and 38% compared to 21 and 31% respectively, P < 0.05). When patients were provided with detailed oral and written information, they declared having a better understanding (4.3 and 4.4 compared to 3.8 respectively, P < 0.001), a higher level of confidence in their OP (4.4 and 4.3 compared to 3.7 and 4 respectively, P < 0.001), a higher level of satisfaction (4.3 and 4.4 compared to 3.8 respectively, P < 0.001) and a higher sense of control and ability to correct the record (1.8 compared to 1.4 respectively, P < 0.01), compared to patients who received partial information. We recommend sharing detailed oral and written medical information with patients in OHS.
... DEPARTMENT OF AGRICULTURE Office of the Secretary [Docket No. APHIS-2012-0104] Privacy Act Systems of Records; Phytosanitary Certificate Issuance and Tracking System AGENCY: Animal and Plant Health... Health Inspection Service proposes to add a system of records to its inventory of records systems subject...
Pai, H H; Lau, F; Barnett, J; Jones, S
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.
Frénot, S; Laforest, F
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.
Cunningham, James; Ainsworth, John
The rise of distributed ledger technology, initiated and exemplified by the Bitcoin blockchain, is having an increasing impact on information technology environments in which there is an emphasis on trust and security. Management of electronic health records, where both conformation to legislative regulations and maintenance of public trust are paramount, is an area where the impact of these new technologies may be particularly beneficial. We present a system that enables fine-grained personalized control of third-party access to patients' electronic health records, allowing individuals to specify when and how their records are accessed for research purposes. The use of the smart contract based Ethereum blockchain technology to implement this system allows it to operate in a verifiably secure, trustless, and openly auditable environment, features crucial to health information systems moving forward.
Sinha, Pradeep K; Bendale, Prashant; Mantri, Manisha; Dande, Atreya
Discover How Electronic Health Records Are Built to Drive the Next Generation of Healthcare Delivery The increased role of IT in the healthcare sector has led to the coining of a new phrase ""health informatics,"" which deals with the use of IT for better healthcare services. Health informatics applications often involve maintaining the health records of individuals, in digital form, which is referred to as an Electronic Health Record (EHR). Building and implementing an EHR infrastructure requires an understanding of healthcare standards, coding systems, and frameworks. This book provides an
Mirza, Hebah; El-Masri, Samir
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.
Full Text Available Background Effective management of chronic diseases such as prostate cancer is important. Research suggests a tendency to use self-care treatment options such as over-the-counter (OTC complementary medications among prostate cancer patients. The current trend in patient-driven recording of health data in an online Personal Health Record (PHR presents an opportunity to develop new data-driven approaches for improving prostate cancer patient care. However, the ability of current online solutions to share patients’ data for better decision support is limited. An informatics approach may improve online sharing of self-care interventions among these patients. It can also provide better evidence to support decisions made during their self-managed care.Aims To identify requirements for an online system and describe a new case-based reasoning (CBR method for improving self-care of advanced prostate cancer patients in an online PHR environment. Method A non-identifying online survey was conducted to understand self-care patterns among prostate cancer patients and to identify requirements for an online information system. The pilot study was carried out between August 2010 and December 2010. A case-base of 52 patients was developed. Results The data analysis showed self-care patterns among the prostate cancer patients. Selenium (55% was the common complementary supplement used by the patients. Paracetamol (about 45% was the commonly used OTC by the patients. Conclusion The results of this study specified requirements for an online case-based reasoning information system. The outcomes of this study are being incorporated in design of the proposed Artificial Intelligence (AI driven patient journey browser system. A basic version of the proposed system is currently being considered for implementation.
.... It is USAID's core financial management system and accounting system of record. Phoenix enables USAID..., which are required to perform necessary accounting operations. Phoenix falls under strict regulatory...: name, social security number, details of payroll transactions and work phone numbers. Phoenix imports...
... destruction of magnetic media. * * * * * GNSA 27 System name: Information Assurance Scholarship Program...). Categories of records in the system: Individual information to include: Title, full name, Social Security... information necessary to establish the identity of the individual, including name, address, and taxpayer...
... retirement data; civilian deployment information and adverse and disciplinary action data. Personnel...; civilian deployment information and adverse and disciplinary action data. Personnel information including...; System of Records AGENCY: Office of the Secretary of Defense, DoD. ACTION: Notice to Alter a System of...
... facilities. Categories of records in the system: Name, Social Security Number (SSN), and DoD Electronic Data... Army's Food Service Program. The system facilitates the ordering, receipt, warehousing, and issuance of... user name and password. Data is encrypted in its stored form and cannot be accessed except through the...
... Appendix I to OMB Circular No. A-130, ``Federal Agency Responsibilities for Maintaining Records About... Instruction (DoDI) 1400.25-V810, DoD Civilian Personnel Management System: Injury Compensation; DoDI 1400.25-V850, DoD Civilian Personnel Management System: Unemployment Compensation; DoD 1400.25-M, DoD Civilian...
... given that the United States Department of Agriculture (USDA) is revising two Privacy Act (PA) systems... Agriculture (NIFA), formerly the Cooperative State Research, Education, and Extension Service (CSREES). DATES... INFORMATION: I. Background 1. Two systems of records are being revised. A. State Cooperative Extension Service...
... Records. System location: U.S. Army Human Resources Command, Education Incentives Branch, 1600 Spearhead... Reserve; Army Regulation 621-5, Army Continuing Education System; Army Regulations 621-202, Education... accordance with 28 U.S.C. 1746, in the following format: If executed outside the United States: `I declare...
..., Marine Corps; BUMED Note 6110, Tracking and Reporting Individual Medical Readiness Data; SECNAVINST 6120... persons that are properly screened, cleared, and trained. Access to this system of records and personal... available only to authorized personnel having a need-to-know.'' * * * * * System manager(s) and address...
... that its three existing systems of records know as ``Veterans and Armed Forces Personnel United States... technology, including the following: (a) Use of the Disability Outreach Tracking System (DOTS) which stores... preventing and detecting fraud or abuse by persons in their operations or programs. Routine use number 7 has...
Rodríguez-López, Juan Pedro; Clemmensen, Lars B; Lancaster, Nick
The sedimentary record of aeolian sand systems extends from the Archean to the Quaternary, yet current understanding of aeolian sedimentary processes and product remains limited. Most preserved aeolian successions represent inland sand-sea or dunefield (erg) deposits, whereas coastal systems are ...
..., during the comment period, comments may be viewed online through the Federal Docket Management System... (704) 245-2492. SUPPLEMENTARY INFORMATION: I. Description of Proposed Systems of Records Background The... Federal agencies may be made to assist such agencies in preventing and detecting possible fraud or abuse...
... of records in the system: Delete entry and replace with ``Individual's name, organizational and home..., contact listing files, organizational telephone directories, and listing of office personnel.'' [[Page... are used to control access to the system data, and procedures are in place to deter and detect...
... OF INDIVIDUALS COVERED BY THE SYSTEM: Individuals and institutions who apply for recruitment...). CATEGORIES OF RECORDS IN THE SYSTEM: Individual information to include: Title, full name, Social Security... awarding of recruitment scholarships, retention scholarships or grants under the DoD Information Assurance...
..., Chief Privacy Officer, Office of Information Technology, 202-551-7209. In the Federal Register of August... SECURITIES AND EXCHANGE COMMISSION [Release No. PA-44A; File No. S7-17-10] Privacy Act of 1974: Systems of Records AGENCY: Securities and Exchange Commission. ACTION: Notice to establish systems of...
... a new Privacy Act system of records, JUSTICE/FBI- 021, the Data Integration and Visualization System... provisions of the Privacy Act in order to avoid interference with the national security and criminal law...)(G), (H) and (I); (e)(5) and (8); (f) and (g) of the Privacy Act: (1) Data Integration and...
... records in the system: Name, Social Security Number (SSN), date of birth, home address, place of birth..., Performance Appraisal; 51, Classification; 53, Pay Rates and Systems; 55, Pay Administration; 61, Hours of... Group Statistics; SECNAV Instruction 12250.6, Civilian Human Resources Management in the Department of...
... Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate... a system of records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system... identifiers or contact information. FOR FURTHER INFORMATION CONTACT: Mr. Gregory L. Outlaw, Defense Finance...
... System name: Historical Airman Promotion Master Test File (MTF) (June 11, 1997, 62 FR 31793). Changes... of Senior Airman (E-4) to Senior Master Sergeant (E-8).'' Categories of records in the system: Delete... Infrastructure (PKI)/ Common Access Card (CAC) authentication to lock out unauthorized access. Access to the...
... property interests, identity theft or fraud, or harm to the security or integrity of this system or other... notice of a proposed system of records entitled, ``Treasury/DO .225 --TARP Fraud Investigation...: Supervisory Fraud Specialist, Office of Financial Stability, 1500 Pennsylvania Avenue, NW., Washington, DC...
.... DCIO 01 System name: Defense Industrial Base (DIB) Cyber Security/Information Assurance Records. System location: Director, Defense Industrial Base (DIB) Cyber Security/Information Assurance (CS/IA) Program... Infrastructure Program (DCIP) Management; and DoDI 5205.13, Defense Industrial Base (DIB) Cyber Security...
... Agency, Defense Threat Reduction Agency, Missile Defense Organization, Pentagon Force Protection Agency... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0160] Privacy Act of 1974; System of Records AGENCY: Office of the Secretary of Defense, DoD. ACTION: Notice to add a system of...
... permanently retained are destroyed. Visitor passes and campus access files are destroyed when 15 years old... used to pass through automated turnstile system, access office suites and other work areas; to track..., ACCESSING, RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Paper files and electronic storage...
... have a need-to-know. Individuals responsible for servicing the records in the performance of official... name, nick names, Social Security Number (SSN), gender, date of birth, personal cell phone number, home... address: Delete entry and replace with ``Automated Civil Engineer System/ Interim Work Management System...
....'' The proposed system of records is necessary to the functions performed by the Workplace Solutions... agreement, self-certification home safety checklist, and supervisor-employee checklist; type of telework... practice. SYSTEM MANAGER(S) AND ADDRESS: Director, Financial Operations Department, Pension Benefit...
... & Privacy, and DoD Information Assurance Regulations. Auditing: Audit trail records from all available.../JS Privacy Office, Freedom of Information Directorate, Washington Headquarters Services, 1155 Defense... Defense. DHA 23 System name: Pharmacy Data Transaction Service (PDTS). System location: Primary: Emdeon...
... 10, 2012. ADDRESSES: You may submit comments: Paper Comments Fax: (703) 666-5670. Mail: Chief Privacy... the Privacy Act. It is USAID's core financial management system and accounting system of record... Budget Execution, which are required to perform necessary accounting operations. Phoenix falls under...
... the FBI BRUs expressly as part of this system notice because the entire notice is being republished. While the FBI BRUs provide necessary flexibility in disseminating records from the system, FBI notes...: Elizabeth Withnell, Supervisory Attorney-Advisor, Privacy and Civil Liberties Unit, Office of the General...
... storage media''. Retrievability: Delete ``and Social Security Number''. Safeguards: Delete last sentence...: * * * * * Categories of individuals covered by the system: Delete entry and replace with ``Children and their sponsors... admission to, DLA-managed day care facilities.'' Categories of records in the system: Delete ``Social...
... DEPARTMENT OF DEFENSE Department of the Army [Docket ID USA-2010-0024] Privacy Act of 1974; System... record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This proposed... the public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Department of the Army [Docket ID USA-2011-0023] Privacy Act of 1974; System... existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended... submissions available for public viewing on the Internet at http://www.regulations.gov as they are received...
... DEPARTMENT OF DEFENSE Department of the Army [Docket ID USA-2011-0028] Privacy Act of 1974; System... record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This proposed... available for public viewing on the Internet at http://www.regulations.gov as they are received without...
... establishing this new system of records, FCC/OMD-30, ``FCC Visitors Database,'' is for the FCC's Security...-30 SYSTEM NAME: FCC Visitors Database. SECURITY CLASSIFICATION: The FCC's Security Operations Center... databases are protected by the FCC's security protocols, which include controlled access, passwords, and...
... SYSTEMS: STORAGE: Information is stored manually in file jackets and electronically in office automation.... SAFEGUARDS: The information is stored in safes, locked filing cabinets, and office automation equipment in a... AND DISPOSAL: Records in the system are retained and disposed of in accordance with NARA Job NCI-60-77...
The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System (OCS), Picture Archiving Communication System (PACS), and Laboratory Information System (LIS), as well as Electronic Medical Record (EMR). It is designed so that remote health screening and patient data search can be accessed through a high speed network-even in remote areas-in order to effectively manage data on medical treatment that patients received at their respective hospitals. The existing oriental treatment system is one in which the doctor requires the patient to visit the hospital in person, so as to be able to check the patient's pulse and measure it with his hand for proper diagnosis and treatment. However, due to the recent development of digitalized medical measurement equipment, not only can doctors now check a patient's pulse without touching it directly, but the measured data are computerized and stored into the database as the electronic obligation record. Thus, even if a patient cannot visit the hospital, proper medical treatment is available by analyzing the patient's medical history and diagnosis process in the remote area. Furthermore, when a comprehensive medical testing center system including the people medical examination and diverse physical examination is established, the quality of medical service is expected to be improved than now.
Full Text Available Abstract Background Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents. Methods A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis. Results In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%. The most frequent incident type was treatment (56%. All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%. Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%. Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04. Conclusion Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety.
The scope of participatory design is discussed through the case of a national standard for electronic patient records (EPR) in Denmark. Currently within participatory design, the relationship between participatory methods and techniques on the one hand and critical and emancipatory aims...... on the other hand is discussed. Some argue that participation in itself entails a strive towards democracy, others argue that the tendency to focus upon tools, techniques and the arena of single projects should be supplemented with emancipatory aims, such as technology assessment and critique of dominance....... These issues are discussed through the controversies around the test in late 2004 of a prototype application based on BEHR, a standard developed from 1999 to 2005 for EPRs. I argue that participation is valuable, but that the scope of participatory design should also include critical conceptualizations...
Damschroder, Laura J; Pritts, Joy L; Neblo, Michael A; Kalarickal, Rosemarie J; Creswell, John W; Hayward, Rodney A
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.
Full Text Available Background and Objective: Currently, patient education has been considered in medical centers. Clinical provision, which is one of the legal tools with training-support dimensions, can evaluate the consistency between the implemented procedures and the planned ones. This study aimed to evaluate the process of recording patient education, consistency of record-keeping with perception, and patient satisfaction after implementing clinical supervision. Materials and Methods: This longitudinal, embedded study was conducted during 2013-2015 in three stages of designing, implementation, and evaluation of the supervision program using randomized convenience sampling on 786 monitoring units (medical records of patients being discharged at Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. In the designing stage, the checklists for supervision of recording patient education and consistency of patient perception with the recorded trainings and the patient satisfaction questionnaire were designed and their valididty and reliability were established. In the implementation stage, structure of the monitoring program was designed with the cooperation of eight supervisors. During 12 months, 2333 checklists and questionnaires were completed at the time of hospital discharge in the evaluation stage. Data analysis was performed in SPSS, version 18, using One-way ANOVA. Results: After 12 months of embedded evaluation, the mean score of recording patient education was 88.5±21.75, and the mean scores of patient satisfaction with the training process and consistency between patients’ perception and the recorded trainings were 47.17±21.48 and 73±25.13, respectively. The mean scores of recording patient training and consistency between patients’ perception and the recorded trainings had an increasing trend (P<0.001, while the mean score of patient satisfaction reduced (P<0.001. Conclusion: The results of clinical supervision during
Dennis, J.A.; Marshall, T.O.; Shaw, K.B.
This report describes the thermoluminescent personal radiation dosemeter and its associated automated processing equipment, which are being developed by the National Radiological Protection Board, together with the operation of a computerised dosemeter issue and record keeping system. The main justifications for introducing these systems are improvements in the organizational efficiency of the maintenance of individual dose records, a more flexible and accurate dosimetry system, and economics in operational costs. The dosemeter is based on a numbered aluminium plate containing two lithium fluoride in polytetrafluorethylene disks for the measurement of surface and body dose. This dosemeter is wrapped in thin plastic and labelled with the wearer's name and address. On return, the dosemeter is checked automatically for radioactive contamination; it is unwrapped and evaluated; the dose readings are included in the wearer's stored dose record; the dosemeter is annealed and is then available for re-issue to another wearer. Dose reports and warnings are automatically issued to the wearer or his employer. (author)
Navaneethan, Sankar D; Jolly, Stacey E; Schold, Jesse D; Arrigain, Susana; Nakhoul, Georges; Konig, Victoria; Hyland, Jennifer; Burrucker, Yvette K; Dann, Priscilla Davis; Tucky, Barbara H; Sharp, John; Nally, Joseph V
Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record-based enhanced personal health record to disseminate CKD stage-specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4. Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: ( 1 ) enhanced personal health record only, ( 2 ) patient navigator only, ( 3 ) both, and ( 4 ) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates. Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups ( P =0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups. We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators
Zong, Wei; Wu, Feng; Chu, Lap-Keung; Sculli, Domenic
The quality of master data is crucial for the accurate functioning of the various modules of an enterprise resource planning (ERP) system. This study addresses specific data problems arising from the generation of approximately duplicate material records in ERP databases. Such problems are mainly due to the firm's lack of unique and global identifiers for the material records, and to the arbitrary assignment of alternative names for the same material by various users. Traditional duplicate detection methods are ineffective in identifying such approximately duplicate material records because these methods typically rely on string comparisons of each field. To address this problem, a machine learning-based framework is developed to recognise semantic similarity between strings and to further identify and reunify approximately duplicate material records - a process referred to as de-duplication in this article. First, the keywords of the material records are extracted to form vectors of discriminating words. Second, a machine learning method using a probabilistic neural network is applied to determine the semantic similarity between these material records. The approach was evaluated using data from a real case study. The test results indicate that the proposed method outperforms traditional algorithms in identifying approximately duplicate material records.
Full Text Available Disease recording of cattle is compulsory in Sweden and Norway. Sweden and Denmark also have mandatory disease recording for swine, whereas Finland and Norway only have compulsory recording of infectious diseases. Both compulsory and voluntary systems are databased, the first ones developed in the 1970's. Disease recording at pig slaughtering is somewhat older. The veterinary practitioner, and often also the farmer, can report treated cases as well as fertility disturbances to the systems. Disease recording at slaughter is carried out by veterinarians and inspection officers. The databases are handled by the veterinary authorities or the agricultural organisations in each country. Costs are defrayed by the authorities and/or the agricultural industry. The farmers receive periodic reports. Data are stored for three to ten years, often longer. Affiliation to animal health schemes for cattle or swine is voluntary. In Sweden and Denmark (cattle they are run within the scope of government regulations. Affiliation to animal health programmes may also be demanded by organisations within the agricultural industry. These organisations are also responsible for the administration of the programmes. Costs to take part in herd health schemes are covered by the farmers themselves. In certain cases, grants are received from agricultural organisations, authorities, or the European Union. Recording of diseases and the format of animal health schemes in the Nordic countries are described here in order to illustrate the possibilities to compare data between countries.
Virginio, Luiz A; Ricarte, Ivan Luiz Marques
Although Electronic Health Records (EHR) can offer benefits to the health care process, there is a growing body of evidence that these systems can also incur risks to patient safety when developed or used improperly. This work is a literature review to identify these risks from a software quality perspective. Therefore, the risks were classified based on the ISO/IEC 25010 software quality model. The risks identified were related mainly to the characteristics of "functional suitability" (i.e., software bugs) and "usability" (i.e., interface prone to user error). This work elucidates the fact that EHR quality problems can adversely affect patient safety, resulting in errors such as incorrect patient identification, incorrect calculation of medication dosages, and lack of access to patient data. Therefore, the risks presented here provide the basis for developers and EHR regulating bodies to pay attention to the quality aspects of these systems that can result in patient harm.
... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.1 Statutory authority for confidentiality of drug abuse patient records. The restrictions of these regulations upon the disclosure and use of drug abuse patient records were initially authorized by section 408...
Tuil, W.S.; Hoopen, A.J. ten; Braat, D.D.M.; Vries Robbé, P.F. de; Kremer, J.A.M.
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
Kluge, E H
An electronic patient record consists of electronically stored data about a specific patient. It therefore constitutes a data-space. The data may be combined into a patient profile which is relative to a particular specialty as well as phenomenologically unique to the specific professional who constructs the profile. Further, a diagnosis may be interpreted as a path taken by a health care professional with a certain specialty through the data-space relative to the patient profile constructed by that professional. This way of looking at electronic patient records entails certain ethical implications about privacy and accessibility. However, it also permits the construction of artificial intelligence and competence algorithms for health care professionals relative to their specialties.
... of Records; LabWare Laboratory Information Management System AGENCY: Animal and Plant Health... system of records, entitled LabWare Laboratory Information Management System (LabWare LIMS), to maintain... Affairs, OMB. Thomas J. Vilsack, Secretary. SYSTEM NAME: LabWare Laboratory Information Management System...
Heard, S R; Roberts, C; Furrows, S J; Kelsey, M; Southgate, L
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
Consolidated Health Informatics (CHI) project, one of the 24 electronic government ( eGov ) Internet- based technology initiatives supporting the president’s...United States Department of Defense (DoD) has transformed health care delivery in its use of information technology to automate patient data...use throughout the Federal Government . The importance of standards in EHR systems was further recognized in an IOM report, which stated, “Electronic
Nahm, Eun-Shim; Diblasi, Catherine; Gonzales, Eva; Silver, Kristi; Zhu, Shijun; Sagherian, Knar; Kongs, Katherine
Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current
Urquhart, Christine; Currell, Rosemary; Grant, Maria J; Hardiker, Nicholas R
A nursing record system is the record of care that was planned or given to individual patients and clients by qualified nurses or other caregivers under the direction of a qualified nurse. Nursing record systems may be an effective way of influencing nurse practice. To assess the effects of nursing record systems on nursing practice and patient outcomes. For the original version of this review in 2000, and updates in 2003 and 2008, we searched: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; MEDLINE, EMBASE, CINAHL, BNI, ISI Web of Knowledge, and ASLIB Index of Theses. We also handsearched: Computers, Informatics, Nursing (Computers in Nursing); Information Technology in Nursing; and the Journal of Nursing Administration. For this update, searches can be considered complete until the end of 2007. We checked reference lists of retrieved articles and other related reviews. Randomised controlled trials (RCTs), controlled before and after studies, and interrupted time series comparing one kind of nursing record system with another in hospital, community or primary care settings. The participants were qualified nurses, students or healthcare assistants working under the direction of a qualified nurse, and patients receiving care recorded or planned using nursing record systems. Two review authors (in two pairs) independently assessed trial quality and extracted data. We included nine trials (eight RCTs, one controlled before and after study) involving 1846 people. The studies that evaluated nursing record systems focusing on relatively discrete and focused problems, for example effective pain management in children, empowering pregnant women and parents, reducing loss of notes, reducing time spent on data entry of test results, reducing transcription errors, and reducing the number of pieces of paper in a record, all demonstrated some degree of success in achieving the desired results. Studies of nursing care planning
Pinnell, R. C.; Dempster, J.; Pratt, J.
Objective. Elucidation of neural activity underpinning rodent behaviour has traditionally been hampered by the use of tethered systems and human involvement. Furthermore the combination of deep-brain stimulation (DBS) and various neural recording modalities can lead to complex and time-consuming laboratory setups. For studies of this type, novel tools are required to drive forward this research. Approach. A miniature wireless system weighing 8.5 g (including battery) was developed for rodent use that combined multichannel DBS and local-field potential (LFP) recordings. Its performance was verified in a working memory task that involved 4-channel fronto-hippocampal LFP recording and bilateral constant-current fimbria-fornix DBS. The system was synchronised with video-tracking for extraction of LFP at discrete task phases, and DBS was activated intermittently at discrete phases of the task. Main results. In addition to having a fast set-up time, the system could reliably transmit continuous LFP at over 8 hours across 3-5 m distances. During the working memory task, LFP pertaining to discrete task phases was extracted and compared with well-known neural correlates of active exploratory behaviour in rodents. DBS could be wirelessly activated/deactivated at any part of the experiment during EEG recording and transmission, allowing for a seamless integration of this modality. Significance. The wireless system combines a small size with a level of robustness and versatility that can greatly simplify rodent behavioural experiments involving EEG recording and DBS. Designed for versatility and simplicity, the small size and low-cost of the system and its receiver allow for enhanced portability, fast experimental setup times, and pave the way for integration with more complex behaviour.
Zhang, Jianguo; Sun, Jianyong; Yang, Yuanyuan; Liang, Chenwen; Yao, Yihong; Cai, Weihua; Jin, Jin; Zhang, Guozhen; Sun, Kun
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.
... past five years and any motor vehicle accidents within the past five years, training and performance record, and other related papers.'' AUTHORITY FOR MAINTENANCE OF THE SYSTEM: Delete entry and replace... past five years and any motor vehicle accidents within the past five years, training and performance...
..., individual's name; sex; race; citizenship; date and place of birth; address(es); telephone number(s); Social... to economic or property interests, identity theft, or fraud, or harm to the security or integrity of..., RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Electronic storage media. [[Page 24932...
...: Electronic storage media and paper records. Retrievability: Retrieved by individual's name and Social... individual's full name, Social Security Number (SSN), address and be signed. The system manager may require an original signature or a notarized signature as a means of proving the identity of the individual...
... information in IMLS' possession, a violation or potential violation of the law (whether civil, criminal, or... system of records may be used as a data source for management information, for the production of summary...: Institute of Museum and Library Services (IMLS), National Foundation on the Arts and Humanities. ACTION...
... OMB Circular No. A-130, ``Federal Agency Responsibilities for Maintaining Records About Individuals... by the system: Delete entry and replace with ``Civilian employees serviced by the Washington.... 1597, Civilian positions: guidelines for reductions; 5 CFR 351, Chapter 1-Office of Personnel...
..., ``Federal Agency Responsibilities for Maintaining Records About Individuals,'' dated February 8, 1996... individuals covered by the system: Delete entry and replace with ``DoD military and civilian personnel... Benefit Program for DoD military and civilian personnel applying for and in receipt of fare subsidies...
... storage media. Retrievability: Individual's name and last four of Social Security Number (SSN). Safeguards....'' * * * * * Categories of records in the system: Delete entry and replace with ``Name, last four of Social Security... address, Smartrip card number, and usage history from Washington Metropolitan Area Transit Authority...
... electronic storage media. Retrievability: Individual's name and last four of Social Security Number (SSN... commuting to and from work. Categories of records in the system: Name, last four of Social Security Number... work number, email address, duty/work address, transit authority card number, and usage from benefit...
... uses this information to obtain customer feedback concerning their service experience and the level of... listed under ``COMMERCE/ PAT-TM-20 Customer Call Center, Assistance and Satisfaction Survey Records... through the agency's telephone support system or customer service centers. The Privacy Act notice is being...
...'' student, as defined in DoD Joint Travel Regulation, Volume 2, Appendix A (JTR V. 2, App. A). Access is... student records of their ``dependent'' student, as defined in DoD Joint Travel Regulation, Volume 2....'' Categories of individuals covered by the system: Delete entry and replace with ``Current and former students...
... folders and electronic storage media. Retrievability: By surname or Social Security Number (SSN....'' Categories of records in the system: Delete entry and replace with ``Name, Social Security Number (SSN... Academy, his/her scholastic and athletic achievements, performance, motivation, discipline, final standing...
... Management System Office, 4800 Mark Center Drive East Tower, 2nd Floor, Suite 02G09, Alexandria, VA 22350... Security and Governmental Affairs, and the Office of Management and Budget (OMB) pursuant to paragraph 4c... Name: Deliberate and Crisis Action Planning and Execution Segment (DCAPES) Records (July 2, 2009, 74 FR...
... ``Access is limited to officials/ employees of the office who have a need to know. Files are stored in.... Investigation working papers are destroyed after 2 years. Database tracking records are destroyed when no longer... covered by the system: Any person who has been the subject of, witness for, or referenced in an...
... Defense. HDTRA 017 Voluntary Leave Sharing Program Records (August 3, 2005; 70 FR 44573). Changes: System... Agency (DTRA) Voluntary Leave Sharing Program. The recipient's name, and a brief description of the... Labor in connection with a claim filed by an employee for compensation due to a job-related injury or...
.... Street West, Randolph AFB, TX 78150-4750. Records are also located at Air Force units of assignment...D ID Number), rank, date of birth, duty phone, height, weight, physical fitness test scores... are properly screened and cleared for need-to-know. System software uses Primary Key Infrastructure...
....regulations.gov . Follow the instructions for submitting comments. Mail: Federal Docket Management System...: Mr. Leroy Jones, Department of the Army, Privacy Office, U.S. Army Records Management and... address, counselor's phone number and email, documentary evidence, affidavits, information from individual...
... that documentary (physical, ``hard copies,'' paper, etc.) records are maintained in the same method as.... ADDRESSES: The public, Office of Management and Budget (OMB), and Congress are invited to submit [[Page...), storage area networks, or tape backup systems. Documentary (physical, ``hard copies,'' paper, etc...
... employment; disciplinary history; business relationships; and similar information relating to the categories... Reference Room, 100 F Street, NE., Washington, DC 20549, on official business days between the hours of 10 a... electronic and paper records in this system may include: name, business address, residential address (for...
... Lifeline Program system of records covers the PII that the Eligible Telecommunications Carriers (ETCs) must... PII that enables USAC to recertify the eligibility of current Lifeline Program subscribers of ETCs who... verification service not in the control of USAC or the Commission; 2. The information that ETCs that elect to...
... information, finance number(s), duty location, and pay location. 2. Non-employee information: Name, gender... application will enable the Postal Service headquarters Equal Employment Opportunity and Workplace Environment.... CATEGORIES OF RECORDS IN THE SYSTEM: [CHANGE TO READ] 1. Employee information: Name, gender, Social Security...
... Agency Responsibilities for Maintaining Records About Individuals,'' dated February 8, 1996 (February 20... passes, payroll information, Social Security Number (SSN), time and attendance, performance, awards and... employment with NGA.'' System manager(s) and address: Delete entry and replace with ``Corporate Applications...
... Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate.... SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records, T7905, entitled...: Mr. Gregory L. Outlaw, Defense Finance and Accounting Service, Freedom of Information/Privacy Act...
.... SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records, T7340c... identifiers or contact information. FOR FURTHER INFORMATION CONTACT: Mr. Gregory L. Outlaw, Defense Finance and Accounting Service, Freedom of Information/Privacy Act Program Manager, Corporate Communications...
... Manager, Corporate Communications, Defense Finance and Accounting Service, DFAS-HKC/IN, 8899 E. 56th... inquires to FOIA/PA Program Manager, Corporate Communications, Defense Finance and Accounting Service, DFAS...; Systems of Records AGENCY: Defense Finance and Accounting Service, Department of Defense, (DoD). ACTION...
... of birth, personal address, personal home and cell phone numbers, personal e-mail address, occupation...; existence of medical conditions or history such as asthma, diabetes, stroke, etc.; and consent to treatment..., Ships, and Submarines. Categories of records in the system: Name, date and place of birth, personal...
... of 1974 training. Retention and disposal: Disposition pending (treat records as permanent until the... Vision Registry (DVEIVR). System location: Primary location: Deputy Assistant Secretary of Defense, Force..., Treatment, and Rehabilitation of Military Eye Injuries; 10 U.S.C. chapter 55, Medical and Dental Care; 45...
... in Higher Education Study. 18-13-08 Early Reading First National Evaluation. 18-13-10 Impact.... Audrey Pendleton, Associate Commissioner, Evaluation Division, National Center for Education Evaluation... systems of records are deleted: 1. (18-13-04) Outcomes of Diversity in Higher Education Study, 64 FR 30106...
National Academy of Sciences - National Research Council, Washington, DC. Transportation Research Board.
The papers contained in the issue of Highway Research Record focus on current and emerging patterns of education and training related to transportation systems planning. The five papers are: Transportation Centers and Other Mechanisms to Encourage Interdisciplinary Research and Training Efforts in Transportation (Frederick J. Wegmann and Edward A.…
... Homeland Security and Governmental Affairs, the Chair of the House Committee on Oversight and Government... Chair of the House of Representatives Committee on Oversight and Government Reform. A system of records... (National SMART) Grant Program, the Teacher Education Assistance for College and Higher Education (TEACH...
... Number (SSN), date of birth, citizenship, race/ethnicity, personal cell phone numbers, mailing/home..., employment information, education information, DoD ID Number, gender, place of birth, personal email address... Management System and Education and Training Records, and from the individual.'' * * * * * [FR Doc. 2012...
... General. Categories of records in the system: Individual's name, Social Security Number (SSN), employee...; memoranda; and working papers regarding, developed, or obtained as a result of investigation or complaint... Justice or any other agency responsible for representing NSA/CSS interests in connection with a judicial...
.../privacy/SORNs/govt/Gov_Wide_Notices.html . K700.13 602-26, Retention Register Files (February 22, 1993, 58... systems of records notices K700.13 602-26, Retention Register Files (February 22, 1993, 58 FR 10562); K700...
... organization, office symbol/code, job title, job function, grade/rank, job series, military specialty, start... the locks, security personnel and administrative procedures.'' Retention and disposal: Delete entry... approves the retention and disposal schedule, records will be treated as permanent.'' System manager(s) and...
... Geospatial-Intelligence Agency Maritime Safety Office Metrics Database. System location: Records are... are limited to government employees in the NGA Source Operations Directorate, Maritime Safety Office... Regulations. Purpose(s): The Maritime Safety Office collects, uses, maintains, and disseminates information to...
... electronic storage media. RETRIEVABILITY: Individual's name, Social Security Number (SSN), or date of birth... facilities. CATEGORIES OF RECORDS IN THE SYSTEM: Subject individual's full name, Social Security Number (SSN... and address; children's names, dates of birth, address and telephone number; parents names, addresses...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DoD-2013-OS-0050] Privacy Act of 1974... notice in its existing inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as... members of the public is to make these submissions available for public viewing on the Internet at http...
... DEPARTMENT OF DEFENSE Department of the Air Force [Docket ID: USAF-2010-0014] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... Internet at http://www.regulations.gov as they are received without change, including any personal...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0020] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... the public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Department of the Air Force [Docket ID: USAF-2010-0012] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0097] Privacy Act of 1974... notice in its existing inventory of records systems subject to the Privacy Act of 1974, (5 U.S.C. 552a... submissions available for public viewing on the Internet at http://www.regulations.gov as they are [[Page...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD-2011-OS-0017] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... public is of make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2012-OS-0072] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... available for public viewing on the Internet at http://www.regulations.gov as they are received without...
... DEPARTMENT OF DEFENSE Department of the Army [Docket ID: USA-2011-0025] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES... submissions available for public viewing on the Internet at http:// [[Page 63612
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0102] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0040] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... viewing on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0023] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... from members of the public is to make these submissions available for public viewing on the Internet at...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0117] Privacy Act of 1974... notice from its existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a... submissions available for public viewing on the Internet at http://www.regulations.gov as they are received...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD-2010-OS-0117] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES... available for public viewing on the Internet at http://www.regulations.gov as they are received without...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0078] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DoD-2013-OS-0110] Privacy Act of 1974... notice in its existing inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as... members of the public is to make these submissions available for public viewing on the Internet at http...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DoD-2012-OS-0132] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. [[Page... Internet at http://www.regulations.gov as they are received without change, including any personal...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0120] Privacy Act of 1974... notice from its existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a... submissions available for public viewing on the Internet at http://www.regulations.gov as they are received...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0109] Privacy Act of 1974... notice from its existing inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a... public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD-2010-OS-0021] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Department of the Air Force [Docket ID: USAF-2011-0018] Privacy Act of 1974... of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0001] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... from members of the public is to make these submissions available for public viewing on the Internet at...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD-2010-OS-0168] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD-2011-OS-0044] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... from members of the public is to make these submissions available for public viewing on the Internet at...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0067] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Department of the Air Force [Docket ID: USAF-2011-0001] Privacy Act of 1974... of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... the public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DoD-2013-OS-0011] Privacy Act of 1974... record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This proposed... public is to make these submissions available for public viewing on the Internet at http:// [[Page 6079...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD-2012-OS-0074] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES... available for public viewing on the Internet at http://www.regulations.gov as they are received without...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DoD-2013-OS-0201] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, as amended. DATES: This proposed action will... submissions available for public viewing on the Internet at http://www.regulations.gov as they are received...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0037] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Department of the Navy [Docket ID: USN-2010-0007] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... viewing on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DoD-2013-OS-0005] Privacy Act of 1974... of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... of the public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DOD-2012-OS-0119] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a(r)), as amended. DATES: This... public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0077] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES... on the Internet at http:// [[Page 33789
... DEPARTMENT OF DEFENSE Department of the Air Force [Docket ID: USAF-2010-0026] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... for public viewing on the Internet at http://www.regulations.gov as they are received without change...
... DEPARTMENT OF DEFENSE Department of the Army [Docket ID: USA-2010-0013] Privacy Act of 1974... inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0035] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... on the Internet at http://www.regulations.gov as they are received without change, including any...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0147] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. [[Page... available for public viewing on the Internet at http://www.regulations.gov as they are received without...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DoD-2012-OS-0030] Privacy Act of 1974... inventory of records systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This... make these submissions available for public viewing on the Internet at http://www.regulations.gov as...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DoD-2012-OS-0133] Privacy Act of 1974... existing inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES... Internet at http://www.regulations.gov as they are received without change, including any personal...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DoD-2013-OS-0040] Privacy Act of 1974... of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... of the public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID DoD-2013-OS-0019] Privacy Act of 1974... record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This proposed... public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2010-OS-0004] Privacy Act of 1974... its existing inventory of record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as... available for public viewing on the Internet at http://www.regulations.gov as they are received without...
... DEPARTMENT OF DEFENSE Office of the Secretary [Docket ID: DOD-2011-OS-0052] Privacy Act of 1974... existing inventory of records systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES... the public is to make these submissions available for public viewing on the Internet at http://www...
... DEPARTMENT OF DEFENSE Department of the Army [Docket ID: USA-2010-0026] Privacy Act of 1974... record systems subject to the Privacy Act of 1974, (5 U.S.C. 552a), as amended. DATES: This proposed... from members of the public is to make these submissions available for public viewing on the Internet at...
... DEPARTMENT OF DEFENSE Department of the Army [Docket ID: USA-2013-0027] Privacy Act of 1974... of record systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. DATES: This... of the public is to make these submissions available for public viewing on the Internet at http://www...
... Civil Liberties Office Web site at http://dpclo.defense.gov/privacy/SORNs/component/army/index.html... systems of records notices. Individual should provide full name, SSN and/or DoD ID number and military... penalty of perjury under the laws of the United States of America that the foregoing is true and correct...
... the existence and character of record systems maintained by the agency (5 U.S.C. 522a(e)(4)). DATES... would also include electronic business card applications. USAID Offices, Bureaus, Missions, or Teams....gov and information collected on Agency Telework forms. This would also include electronic business...
... records to the Department of Justice (DoJ), either on VA's initiative or in response to DoJ's request for... BY THE SYSTEM: VA employees who apply for and are denied or granted educational assistance awards...) award amount, (6) obligated service incurred, and (7) name and address of the educational institution...
... DEPARTMENT OF EDUCATION Privacy Act of 1974; System of Records AGENCY: Office of Planning..., 2012. FOR FURTHER INFORMATION CONTACT: Carmel Martin, Assistant Secretary for Planning, Evaluation and... 20202- 4500. Telephone: (202) 401-3676. If you use a telecommunications device for the deaf (TDD) or a...
... facilities and lockable containers. Access to electronic means is controlled by computer password protection... Security Service computers and software. CATEGORIES OF RECORDS IN THE SYSTEM: The user's name, Social... involved or where sensitive national security investigations related to protection of intelligence sources...
... Business Innovative Research (SBIR) Organizations/Groups. CATEGORIES OF RECORDS IN THE SYSTEM: Information... title, by any of the following methods: * Federal Rulemaking Portal: http://www.regulations.gov . Follow...,'' dated February 8, 1996 (February 20, 1996; 61 FR 6427). Dated: September 29, 2010. Mitchell S. Bryman...
... Service Candidate Development programs, Ethics, Professional Development Plans, Supervisory Training, Open... [cir] Professional Assessment surveys such as Executive Career Field Candidate/Mentor questionnaires... the system: Storage: Records are maintained on the HPDM1 Server and backup server in Little Rock...
Matsuo, Toshihiko; Gochi, Akira; Hirakawa, Tsuyoshi; Ito, Tadashi; Kohno, Yoshihisa
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.
Jensen, Roxanne E; Snyder, Claire F; Basch, Ethan; Frank, Lori; Wu, Albert W
In recent years, patient-reported outcomes have become increasingly collected and integrated into electronic health records. However, there are few cross-cutting recommendations and limited guidance available in this rapidly developing research area. Our goal is to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on this topic and a summary of actions that followed from the workshop, and present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use. These findings provide actionable guidance across research and practice settings to promote and sustain widespread adoption of patient-reported outcomes across patient populations, healthcare settings and electronic health record systems.
Since May 1978 the exposure of personnel to external radiation has been assessed by Thermoluminescent Dosimetry, (TLD). The dosemeter consists of a TLD card similar to that used by the National Radiological Protection Board, held in a plastic badge designed at AEE Winfrith, and used in conjunction with a D A Pitman Ltd Type 605 Automatic Reader. The report describes the dosemeter, the operation of the dosimetry service and the system for maintaining a computerised record keeping system. (author)
Conclusions Progress toward a problem-oriented EPR system based on episodes of care that includes decision support is necessary to satisfy the needs expressed by GPs. Further research could solve the problem of integration of functionality for consultation with specialists and integration with patient held records. Results from this study could contribute to further development of the next generation of EPRs in primary care, as well as inspire the application of EPRs in other parts of the health sector.
Bowden, Tom; Coiera, Enrico
The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved. Twenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients. Reported utilization rates by clinicians was variable, with rates >20% amongst health management organizations but much lower in nation-scale systems. No study reported on clinical outcomes or patient safety, and no economic studies of SEHR access during unscheduled care were available. Design factors that may affect utilization included consent and access models, SEHR content, and system usability and reliability. Despite their size and expense, SEHRs designed to support unscheduled care have been poorly evaluated, and it is not possible to draw conclusions about any likely benefits associated with their use. Heterogeneity across the systems and the populations they serve make generalization about system design or performance difficult. None of the reviewed studies used a theoretical model to guide evaluation. Value of Information models may be a useful theoretical approach to design evaluation metrics, facilitating comparison across systems in future studies. Well-designed SEHRs should in principle be capable of improving the efficiency, quality and safety of unscheduled care, but at present the evidence for such benefits is weak, largely because it has not been sought.
Hue, Pham Thi Bach; Wohlgemuth, Sven; Echizen, Isao; Thuy, Dong Thi Bich; Thuc, Nguyen Dinh
There needs to be a strategy for securing the privacy of patients when exchanging health records between various entities over the Internet. Despite the fact that health care providers such as Google Health and Microsoft Corp.'s Health Vault comply with the U.S Health Insurance Portability and Accountability Act (HIPAA), the privacy of patients is still at risk. Several encryption schemes and access control mechanisms have been suggested to protect the disclosure of a patient's health record especially from unauthorized entities. However, by implementing these approaches, data owners are not capable of controlling and protecting the disclosure of the individual sensitive attributes of their health records. This raises the need to adopt a secure mechanism to protect personal information against unauthorized disclosure. Therefore, we propose a new Fine-grained Access Control (FGAC) mechanism that is based on subkeys, which would allow a data owner to further control the access to his data at the column-level. We also propose a new mechanism to efficiently reduce the number of keys maintained by a data owner in cases when the users have different access privileges to different columns of the data being shared.
Sugiyama, Atsushi; Hachisu, Takuma; Osaka, Tetsuya
In the advanced information society of today, information storage technology, which helps to store a mass of electronic data and offers high-speed random access to the data, is indispensable. Against this background, hard disk drives (HDD), which are magnetic recording devices, have gained in importance because of their advantages in capacity, speed, reliability, and production cost. These days, the uses of HDD extend not only to personal computers and network servers but also to consumer electronics products such as personal video recorders, portable music players, car navigation systems, video games, video cameras, and personal digital assistances.
Leonard, D C; Pons, Alexander P; Asfour, Shihab S
The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one, and, once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data has benefited all participants, but one of the outstanding problems that must be addressed is how the creation of a standardized nationwide electronic healthcare record system in the United States would uniquely identify and match a composite of an individual's recorded healthcare information to an identified individual patients out of approximately 300 million people to a 1:1 match. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our fingerprint, iris, retina scan, and DNA (FIRD) framework, which is a multiphase system whose primary phase is a multilayer consisting of these four types of biometric identifiers: 1) fingerprint; 2) iris; 3) retina scan; and 4) DNA. In addition, it also consists of additional phases of integration, consolidation, and data discrepancy functions to solve the unique association of a patient to their medical data distinctively. This would allow a patient to have real-time access to all of their recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.
Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne
To examine the association between patient loyalty, as measured by member retention in the health plan, and access to My Health Manager (MHM), Kaiser Permanente's PHR, which is linked to its electronic health record, KP HealthConnect. We conducted a retrospective cohort observational quality improvement project from the third quarter of 2005 to the fourth quarter of 2008 for approximately 394,000 Kaiser Permanente Northwest members. To control for self-selection bias, we used propensity scores to perform exact 1-to-1 matching without replacement between MHM users and nonusers. We estimated retention rates of the matched data and assessed the association between MHM use and retention versus voluntary termination. We also estimated odds ratios of significant variables impacting member retention. The probability of remaining a member or being involuntarily terminated versus voluntary termination was 96.7% for users (95% confidence interval [CI], 96.6%-96.7%) and 92.2% for nonusers (95% CI, 92.1%-92.4%; P loyalty, retention is critical to healthcare organizations.
Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilacopoulos, George; Prentza, Andrianna; Kyriazis, Dimosthenis; Malamateniou, Flora; Maglaveras, Nicos; Chouvarda, Ioanna; Mourouzis, Alexandros
The purpose of this paper is to introduce the Patient-Centered e-Health (PCEH) conceptual aspects alongside a multidisciplinary project that combines state-of-the-art technologies like cloud computing. The project, by combining several aspects of PCEH, such as: (a) electronic Personal Healthcare Record (e-PHR), (b) homecare telemedicine technologies, (c) e-prescribing, e-referral, e-learning, with advanced technologies like cloud computing and Service Oriented Architecture (SOA), will lead to an innovative integrated e-health platform of many benefits to the society, the economy, the industry, and the research community. To achieve this, a consortium of experts, both from industry (two companies, one hospital and one healthcare organization) and academia (three universities), was set to investigate, analyse, design, build and test the new platform. This paper provides insights to the PCEH concept and to the current stage of the project. In doing so, we aim at increasing the awareness of this important endeavor and sharing the lessons learned so far throughout our work.
Andries, A.; Bivol, V.; Iovu, M
The invention relates to the semiconducting silverless photography, in particular to the technique for optical information recording and may be used in microphotography for manifacture of microfiches, microfilms, storage disks, i the multiplication and copying technique, in holography, in micro- and optoelectronics, cinematography etc. The system for optical images and holographic information recording includes an optical exposure system, an information carrier , containing a dielectric substrate with the first electrode, a photosensitive element and the second electrode, arranged in consecutive order, a constant and impulse voltage source, a means for climbing and movement of the information carrier, a control unit for connection of the voltage source to the electroconducting strate, a personal computer, connected to the control unit of the recording modes ,to the exposure system and the information carrier, an electrooptical transparency, connected to the computer by means of the matching unit. The carrier for optical images and holographic information recording contains a dielectric substrate, a photosensitive element formed of a layer of the vitreous chalcogenic semiconductor and a layer of the crystalline or amorphous semiconductor, forming a heterojunction, the photosensitive element is arranged between two electrodes , one of which is made transparent , in such case rge layer of the vitreous chalcogenic semiconductor comes into contact with the superior transparent electrode, subjected to exposure
Pickett, R. B.; Matthews, F. L.
Independent PCM telemetry data signals received from missiles must be correlated to within + or - 100 microseconds for comparison with radar data. Tests have been conducted to determine RF antenna receiving system delays; delays associated with wideband analog tape recorders used in the recording, dubbing and repdocuing processes; and uncertainties associated with computer processed time tag data. Several methods used in the recording of timing are evaluated. Through the application of a special time tagging technique, the cumulative timing bias from all sources is determined and the bias removed from final data. Conclusions show that relative time differences in receiving, recording, playback and processing of two telemetry links can be accomplished with a + or - 4 microseconds accuracy. In addition, the absolute time tag error (with respect to UTC) can be reduced to less than 15 microseconds. This investigation is believed to be the first attempt to identify the individual error contributions within the telemetry system and to describe the methods of error reduction within the telemetry system and to describe the methods of error reduction and correction.
Full Text Available As the Electronic Health Record (EHR systems constantly expand to support more clinical activities and their implementations in healthcare organizations become more widespread, several communities have been working intensively for several years to develop open access and open source EHR software, aiming at reducing the costs of EHR deployment and maintenance. In this paper, we describe and evaluate the most popular open source electronic medical records such as openEMR, openMRS and patientOS, providing their technical features and potentials. These systems are considered quite important due to their prevalence. The article presents the key features of each system and outlines the advantages and problems of Open Source Software (OSS Systems through a review of the literature, in order to demonstrate the possibility of their adoption in modern electronic healthcare systems. Also discussed are the future trends of OS EHRs in the context of the Personal Health Records and mobile computing paradigm.
FR Doc. 83-18581, appearing at page 31738 in the issue of Monday, July 11, 1983, provided notification of a new system of records proposed by the Health Resources and Services Administration (HRSA). That system is 09-15-0045, "Health Resources and Services Administration Loan Repayment/Debt Management Records System, HHS/HRSA/OA." The document stated that the Public Health Service had requested that the Office of Management and Budget (OMB) grant a waiver of the usual requirement that a system of records not be put into effect until 60 days after the report is sent to OMB and the Congress OMB granted the requested waiver on August 3, 1983. Accordingly, the new system of records, 09-15-0045, became effective upon the date of the waiver except for the routine uses established for the system. They became effective August 11, 1983, following the public comment period. However, in response to a comment received from the responsible oversight committee of the U.S. House of Representatives, we are adding a routine use to permit disclosure of information from these records to the General Accounting Office (GAO) and OMB for auditing financial obligations. We are also modifying one of the existing routine uses. PHS invites interested parties to submit comments on the proposed new routine use on or before September 29, 1983. In accordance with the Debt Collection Act of 1982 (Pub. L. 97-365), we are also adding the "special disclosure" statement. This statement does not require a public comment period.
Víctor Manuel González-Chordá
Full Text Available The main objective of the present work is to analyze the results of the utilization and evaluation of the LORETO Record System (LRS, providing improvement areas in the teaching-learning process and technology, in second year nursing students. A descriptive, prospective, cross sectional study using inferential statics has been carried out on all electronic records reported by 55 nursing students during clinical internships (April 1º-June 26º, 2013. Electronic record average rated 7.22 points (s=0.6; CV=0.083, with differences based on the clinical practice units (p<0,05. Three items assessed did not exceed the quality threshold set at 0.7 (p<0.05. Record Rate exceeds the quality threshold set at 80% for the overall sample, with differences based on the practice units. Only two clinical practice units rated above the minimum threshold (p <0.05. Record of care provision every 3 days did not reach the estimated quality threshold (p <0.05. There is a dichotomy between qualitative and quantitative results of LRS. Improvement areas in theoretical education have been identified. The LRS seems an appropriate learning and assessment tool, although the development of a new APP version and the application of principles of gamification should be explored.
van der Wal Gerrit
Full Text Available Abstract Background Patient record review is believed to be the most useful method for estimating the rate of adverse events among hospitalised patients. However, the method has some practical and financial disadvantages. Some of these disadvantages might be overcome by using existing reporting systems in which patient safety issues are already reported, such as incidents reported by healthcare professionals and complaints and medico-legal claims filled by patients or their relatives. The aim of the study is to examine to what extent the hospital reporting systems cover the adverse events identified by patient record review. Methods We conducted a retrospective study using a database from a record review study of 5375 patient records in 14 hospitals in the Netherlands. Trained nurses and physicians using a method based on the protocol of The Harvard Medical Practice Study previously reviewed the records. Four reporting systems were linked with the database of reviewed records: 1 informal and 2 formal complaints by patients/relatives, 3 medico-legal claims by patients/relatives and 4 incident reports by healthcare professionals. For each adverse event identified in patient records the equivalent was sought in these reporting systems by comparing dates and descriptions of the events. The study focussed on the number of adverse event matches, overlap of adverse events detected by different sources, preventability and severity of consequences of reported and non-reported events and sensitivity and specificity of reports. Results In the sample of 5375 patient records, 498 adverse events were identified. Only 18 of the 498 (3.6% adverse events identified by record review were found in one or more of the four reporting systems. There was some overlap: one adverse event had an equivalent in both a complaint and incident report and in three cases a patient/relative used two or three systems to complain about an adverse event. Healthcare professionals
Koens, M.L.; Vroome, H. de
The Record and Verify system developed for the radiotherapy department of the Leiden University Hospital is described. The system has been in use since 1980 and will now be installed in at least four of the Dutch University Hospitals. The system provides the radiographer with a powerful tool for checking the set-up of the linear accelerator preceeding the irradiation of a field. After the irradiation of a field the machine settings are registered in the computer system together with the newly calculated cumulative dose. These registrations are used by the system to produce a daily report which provides the management of the department with insight into the established differences between treatment and treatment planning. Buying a record and verify system from the manufacturer of the linear accelerator is not an optimal solution especially for a department with more than one accelerator from different manufacturers. Integration in a Hospital Information System (HIS) has important advantages over the development of a dedicated departmental system. (author)
Chen, Chien-Min; Hou, I-Ching; Chen, Hsiao-Ping; Weng, Yung-Ching
The integrity of electronic nursing records (ENRs) stands for the quality of medical records. But patients' conditions are varied (e.g. not every patient had wound or need fall prevention), to achieve the integrity of ENRs depends much on clinical nurses' attention. Our study site, an one 2,300-bed hospital in northern Taiwan, there are a total of 20 ENRs including nursing assessments, nursing care plan, discharge planning etc. implemented in the whole hospital before 2014. It become important to help clinical nurses to decrease their human recall burden to complete these records. Thus, the purpose of this study was to design an ENRs reminder system (NRS) to facilitate nursing recording process. The research team consisted of an ENR engineer, a clinical head nurse and a nursing informatics specialist began to investigate NRS through three phases (e.g. information requirements; design and implementation). In early 2014, a qualitative research method was used to identify NRS information requirements through both groups (e.g. clinical nurses and their head nurses) focus interviews. According to the their requirements, one prototype was created by the nursing informatics specialist. Then the engineer used Microsoft Visual Studio 2012, C#, and Oracle to designed a web-based NRS (Figure 1). Then the integrity reminder system which including a total of twelve electronic nursing records was designed and the preliminary accuracy validation of the system was 100%. NRS could be used to support nursing recording process and prepared for implementing in the following phase.
Glintborg, Bente; Poulsen, Henrik E; Dalhoff, Kim P
What is already known about this subject: Structured medication interviews improve the medication history upon hospitalization. Pharmacy records are valid lists of the prescribed medications available to individual patients. In Denmark, treating doctors now have access to their patients' pharmacy...... records through a real-time online electronic database What this study adds: Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits. Pharmacy records may be used to minimize patients' recall bias and improve the medication lists....
Learn about the Confidential Business Information Tracking System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedures.
... replace with ``Defense Health Services Systems, Suite 1599, 5203 Leesburg Pike, Falls Church, VA 22041... Data: This includes control number, transaction code, debit amount, credit amount, check number, Batch posting number, balance, patient identification, patient name, encounter date, comments, entry date and...
Tamazirt , Lotfi; Alilat , Farid; Agoulmine , Nazim
International audience; Nowadays, health systems are looking for effective ways to manage more patients in a shorter time, and to increase the quality of care through better coordination to provide quick, accurate and non-invasive diagnostics to patients. This paper aims to solve the dependence on trusted third parties by proposing a new management strategy, storage and security in a decentralized network through Blockchain technology. The proposed system also aims to offer a solution to help...
Ben-Assuli, Ofir; Leshno, Moshe
In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.
Ledbetter, C S; Morgan, M W
Automating clinical and administrative processes via an electronic patient record (EPR) gives clinicians the point-of-care tools they need to deliver better patient care. However, to improve clinical practice as a whole and then evaluate it, healthcare must go beyond basic automation and convert EPR data into aggregated, multidimensional information. Unfortunately, few EPR systems have the established, powerful analytical clinical data warehouses (CDWs) required for this conversion. This article describes how an organization can support best practice by leveraging a CDW that is fully integrated into its EPR and clinical decision support (CDS) system. The article (1) discusses the requirements for comprehensive CDS, including on-line analytical processing (OLAP) of data at both transactional and aggregate levels, (2) suggests that the transactional data acquired by an OLTP EPR system must be remodeled to support retrospective, population-based, aggregate analysis of those data, and (3) concludes that this aggregate analysis is best provided by a separate CDW system.
England, S P
The health care industry is an information-dependent business that will require a new generation of health information systems if successful health care reform is to occur. We critically need integrated clinical management information systems to support the physician and related clinicians at the direct care level, which in turn will have linkages with secondary users of health information such as health payors, regulators, and researchers. The economic dependence of health care industry on the CPR cannot be underestimated, says Jeffrey Ritter. He sees the U.S. health industry as about to enter a bold new age where our records are electronic, our computers are interconnected, and our money is nothing but pulses running across the telephone lines. Hence the United States is now in an age of electronic commerce. Clinical systems reform must begin with the community-based patient chart, which is located in the physician's office, the hospital, and other related health care provider offices. A community-based CPR and CPR system that integrates all providers within a managed care network is the most logical step since all health information begins with the creation of a patient record. Once a community-based CPR system is in place, the physician and his or her clinical associates will have a common patient record upon which all direct providers have access to input and record patient information. Once a community-level CPR system is in place with a community provider network, each physician will have available health information and data processing capability that will finally provide real savings in professional time and effort. Lost patient charts will no longer be a problem. Data input and storage of health information would occur electronically via transcripted text, voice, and document imaging. All electronic clinical information, voice, and graphics could be recalled at any time and transmitted to any terminal location within the health provider network. Hence
Garvey, Thomas D; Evensen, Ann E
Importance: Patients with cervical cytology abnormalities may require surveillance for many years, which increases the risk of management error, especially in clinics with multiple managing clinicians. National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) certification requires tracking of abnormal results and communicating effectively with patients. The purpose of this study was to determine whether a computer-based tracking system that is not embedded in the electronic medical record improves (1) accurate and timely communication of results and (2) patient adherence to follow-up recommendations. Design: Pre/post study using data from 2005-2012. Intervention implemented in 2008. Data collected via chart review for at least 18 months after index result. Participants: Pre-intervention: all women (N = 72) with first abnormal cytology result from 2005-2007. Post-intervention: all women (N = 128) with first abnormal cytology result from 2008-2010. Patients were seen at a suburban, university-affiliated, family medicine residency clinic. Intervention: Tracking spreadsheet reviewed monthly with reminders generated for patients not in compliance with recommendations. Main Outcome and Measures: (1) rates of accurate and timely communication of results and (2) rates of patient adherence to follow-up recommendations. Intervention decreased absent or erroneous communication from clinician to patient (6.4% pre- vs 1.6% post-intervention [P = 0.04]), but did not increase patient adherence to follow-up recommendations (76.1% pre- vs 78.0% post-intervention [ P= 0.78]). Use of a spreadsheet tracking system improved communication of abnormal results to patients, but did not significantly improve patient adherence to recommended care. Although the tracking system complies with NCQA PCMH requirements, it was insufficient to make meaningful improvements in patient-oriented outcomes.