Electronic Health Records Research Papers (original) (raw)

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- by and +1
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- Information Systems, Engineering, Medical Informatics, Documentation

Recently there have been several high-profile ransomware attacks involving hospitals around the world. Ransomware is intended to damage or disable a user's computer unless the user makes a payment. Once the attack has been launched, users have three options: 1) try to restore their data from backup; 2) pay the ransom; or 3) lose their data. In this manuscript, we discuss a socio-technical approach to address ransomware and outline four overarching steps that organizations can undertake to secure an electronic health record (EHR) system and the underlying computing infrastructure. First, health IT professionals need to ensure adequate system protection by correctly installing and configuring computers and networks that connect them. Next, the health care organizations need to ensure more reliable system defense by implementing user-focused strategies, including simulation and training on correct and complete use of computers and network applications. Concomitantly, the organizati...

- by Ken Eason
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- Information Systems, Medical Informatics, Health Informatics, Electronic Health Records
- by Rachel Odesanya
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- Electronic Health Records, Pharmacovigilance, Medicine, Humans

There has not yet been an audit of achievement rates of therapeutic targets for cholesterol management in the rural Italian primary care setting. The purpose of this study was to measure the percentage of patients with hypercholesterolaemia in a rural primary care setting in southern Italy, classify their risk category and measure the proportions of those patients who achieved optimal cholesterol levels according to the Adult Treatment Panel III guidelines. The audit was completed using records from 1 January 2005 to 31 December 2007. An electronic search key was entered into the electronic clinical records of 10 family doctors in a rural area of southern Italy for subjects with a diagnosis of or being treated for hypercholesterolaemia. A total of 194 hypercholesterolaemic patients were randomly selected from a cohort of patients registered with these family doctors. The low density lipoprotein cholesterol (LDL-C) target level was 100 mg/dL (2.6 mmol/L) in patients with existing car...

- by Nicola Buono
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- Nursing, Primary Health Care, Electronic Health Records, Medicine
- by Peter Fifield
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- Mental Health, Job Satisfaction, Electronic Health Records, Medicine

This paper discusses the application of an unsupervised text mining technique for the extraction of information from clinical records in Italian. The approach includes two steps. First of all, a metathesaurus is exploited together with natural language processing tools to extract the domain entities. Then, clustering is applied to explore relations between entity pairs. The results of a preliminary experiment, performed on the text extracted from 57 medical records containing more than 20,000 potential relations, show how the clustering should be based on the cosine similarity distance rather than the City Block or Hamming ones.

- by Francesco Isgrò
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- Computer Science, Data Mining, Electronic Health Records, Medicine
- by Dr. Taufik Hasan
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- Information Systems, Indonesia, Electronic Health Records, Developing Countries
- by Joy Goebel
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- Information Systems, Nursing, Palliative Care, Electronic Health Records

To understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions. Qualitative case study of 6 primary care practices in Virginia. We performed surveys and in-depth interviews with clinicians and administrative staff (N = 38) and observed interpersonal relations and use of EHR functions over a 16-month period. Practices with an established EHR were selected based on a maximum variation of quality activities, location, and ownership. Physicians and staff report increased efficiency in retrieving medical records, storing patient information, coordination of care, and office operations. Costs, lack of knowledge of EHR functions, and problems transforming office operations were barriers reported for meaningful use of EHRs. Major disruption to patient care during upgrad...

- by Kerry Mychaliska
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- Pharmacy, Documentation, Electronic Health Records, Prospective studies
- by Robert Dufour
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- Pathology, Electronic Health Records, Humans, Clinical Sciences
- by Denice Stewart
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- Dentistry, Educational Technology, Electronic Health Records, Workflow

E-health interventions are of a growing importance for self-management of chronic conditions. This study aimed to describe the process adaptions that are needed in cardiac rehabilitation (CR) to implement a self-management system, called MyCARDSS. We created a generic workflow model based on interviews and observations at three CR clinics. Subsequently, a workflow model of the ideal situation after implementation of MyCARDSS was created. We found that the implementation will increase the complexity of existing working procedures because 1) not all patients will use MyCARDSS, 2) there is a transfer of tasks and responsibilities from professionals to patients, and 3) information in MyCARDSS needs to be synchronized with the EPR system for professionals.

- by Roderik Kraaijenhagen
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- Cardiology, Rehabilitation, Electronic Health Records, Workflow
- by susan bewley
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- Obstetrics, Electronic Health Records, Obstetrics Gynecology, Gynecology

This paper explores the improvement of efficiency in e-Health by standardizing access to electronic health
records (EHRs). Without superimposed organizations, EHR will remain an uneven and fragmented network
of lagging systems unable to achieve accuracy and consistency, thus efficiencies. A multinational
corporation (MNC) model is proposed to reduce healthcare costs, and implement a coherent system where
data, technology and training are uniformly upgraded to alleviate interoperability issues. The inference
based on literature review suggests that EHR interoperability issues maybe mitigated by creating common
architectures that enable fragmented systems to interoperate under supra organizations.
Keywords – e-Health; EHR; Multi-national Corporation; Interoperability.

- by Jose Morales
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- Psychometrics, Quality of life, Electronic Health Records, Self Care

The implications of intergovernmental agencies may forever change the way in which governments provide common services within a federated Australia. As governments seek to reduce duplication and inconsistencies across state and territory borders, intergovernmental agencies, born out of intergovernmental agreements, without any link to specific state or territory legislation, are challenging managers to develop, new approaches to procurement and implement information systems within this new legal dynamic framework. This paper considers the implications to managing health related records and their IT systems, having common legislative obligations across all Australia jurisdictions, to determine whether these new forms of government allow for the disposal of information, aimed at saving costs, improving the quality of data and reduce litigious risk. The paper also investigates the more general implications for any organisation operating nationally, to data sovereignty and how legislati...

- by Alex Flores
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- Information Systems, Computer Science, Health Care, Electronic Health Records

В настоящее время в России в целом сформирован рынок программных продуктов для медицины и здравоохранения. Требования государства к развитию информационных технологий для медицины постоянно растут. Начиная с 2019 года объем финансирования будет существенно увеличен. Главной статьей затрат в 2019–2024 гг. будет разработка, развитие и внедрение различных информационных систем для регионального здравоохранения, предусмотренных федеральной программой «Создание единого цифрового контура в сфере здравоохранения». В работе систематизированы наблюдения авторов и прогнозы о том, какие же главные тренды окажут наибольшее влияние на изменение рынка медицинских информационных систем (МИС), и к чему это приведет. Среди основных драйверов и прогнозов рынка: концентрация внимания врача и разработчиков МИС не вокруг ведения электронных документов, а вокруг различных аспектов здоровья и жизни пациента. В области управления взаимоотношениями с пациентами начнется внедрение в практику концепции Patient Relationship Management (PRM). К МИС будут расти требования в части оптимизации лечебно-диагностических процессов, поддержки клинических протоколов и непрерывного аудита качества оказания медицинской помощи. Продолжится развитие систем в сторону централизации, перехода на «облачную» модель работы, включая SaaS, а также импортозамещения. Число разработчиков будет постепенно сокращаться, что приведет к консолидации и укрупнению рынка. Будет расти спрос на интеграцию в МИС систем поддержки принятия врачебных решений, построенных с помощью машинного обучения. Все это в комплексе будет способствовать цифровой трансформации отрасли.

Objective: To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods: This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients’ average travel distance (ATD) to the closest clinic site. Results: A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient loa...

- by Ben Marsh
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- Engineering, Health Planning, Electronic Health Records, Telemedicine
- by Mohammed Bouhajib
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- Bioanalysis, Biomarkers, Electronic Health Records, Laboratories
- by Marjorie Skubic and +2
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- Nursing, Electronic Health Records, Computer Security, Systems Integration
- by Catherine McCarty
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- Genetics, Algorithms, Genetic Epidemiology, Electronic Health Records

Today's rich digital information environment is characterized by the multitude of data sources providing information that has not yet reached its full potential in eHealth. The aim of the presented approach, namely CrowdHEALTH, is to introduce a new paradigm of Holistic Health Records (HHRs) that include all health determinants. HHRs are transformed into HHRs clusters capturing the clinical, social and human context of population segments and as a result collective knowledge for different factors. The proposed approach also seamlessly integrates big data technologies across the complete data path, providing of Data as a Service (DaaS) to the health ecosystem stakeholders, as well as to policy makers towards a "health in all policies" approach. Cross-domain co-creation of policies is feasible through a rich toolkit, being provided on top of the DaaS, incorporating mechanisms for causal and risk analysis, and for the compilation of predictions.

- by Serge Autexier
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- Engineering, Computer Science, Electronic Health Records, Risk assessment
- by Margarita DiVall
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- Electronic Health Records, Curriculum, Software Design, Humans
- by Daniel Lackland
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- Communication, Medication Adherence, Electronic Health Records, California
- by Dean Sittig
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- Patient Safety, Electronic Health Records, Computer Security, Software

To determine whether clinical decision support (CDS) is associated with improved quality indicators and whether disabling CDS negatively affects these. Using the 2006-2009 National Ambulatory and National Hospital Ambulatory Medical Care Surveys, we performed logistic regression to analyze adult primary care visits for the association between the use of CDS (problem lists, preventive care reminders, lab results, lab range notifications, and drug-drug interaction warnings) and quality measures (blood pressure control, cancer screening, health education, influenza vaccination, and visits related to adverse drug events). There were an estimated 900 million outpatient primary care visits to clinics with EHRs from 2006-2009; 97% involved CDS, 77% were missing at least 1 CDS, and 15% had at least 1 CDS disabled. The presence of CDS was associated with improved blood pressure control (86% vs 82%; OR 1.3; 95% CI, 1.1-1.5) and more visits not related to adverse drug events (99.9% vs 99.8%; O...

- by Luca Mazzola and +1
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- Information Systems, Health Information Systems, Electronic Health Records, Italy
- by Zilma Reis and +1
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- Electronic Health Records, Humans, Biomedical Research, Female
- by Robert C . Bowman, Jr.
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- Algorithms, Immunology, Evidence Based Practice, Electronic Health Records

A plethora of digital ECG formats have been proposed and implemented. This heterogeneity hinders the design and development of interoperable systems and entails critical integration issues for the healthcare information systems. This paper aims at performing a comprehensive overview on the current state of affairs of the interoperable exchange of digital ECG signals. This includes 1) a review on existing

- by Ignacio Ruiz
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- Information Systems, Engineering, Cardiology, Ontology

Electronic Medical Records (EMRs) are increasingly used in modern health care. As a result, systematically applying usability principles becomes increasingly vital in creating systems that provide health care professionals with satisfying, efficient, and effective user experiences, as opposed to frustrating interfaces that are difficult to learn, hard to use, and error prone. This study demonstrates how the TURF framework [1] can be used to evaluate the usability of an EMR module and subsequently redesign its interface with dramatically improved usability in a unified, systematic, and principled way. This study also shows how heuristic evaluations can be utilized to complement the TURF framework.

- by Oscar Pinzon
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- Electronic Health Records, Humans, United States, Integration
- by Gwendolyn Quinn
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- Education, Fertility, Electronic Health Records, Adolescent Health
- by Simon Meyer Lauritsen
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- Health Sciences, Machine Learning, Electronic Health Records, Health

The marked increase in radiation exposure from medical imaging, especially in children, has caused considerable alarm and spurred efforts to preserve the benefits but reduce the risks of imaging. Applying the principles of the Image Gently campaign, data-driven process and quality improvement techniques such as process mapping and flowcharting, cause-and-effect diagrams, Pareto analysis, statistical process control (control charts), failure mode and effects analysis, "lean" or Six Sigma methodology, and closed feedback loops led to a multiyear program that has reduced overall computed tomographic (CT) examination volume by more than fourfold and concurrently decreased radiation exposure per CT study without compromising diagnostic utility. This systematic approach involving education, streamlining access to magnetic resonance imaging and ultrasonography, auditing with comparison with benchmarks, applying modern CT technology, and revising CT protocols has led to a more tha...

Patient notes in electronic health records (EHRs) may contain critical information for medical investigations. However, the vast majority of medical investigators can only access de-identified notes, in order to protect the confidentiality of patients. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) defines 18 types of protected health information that needs to be removed to de-identify patient notes. Manual de-identification is impractical given the size of electronic health record databases, the limited number of researchers with access to non-de-identified notes, and the frequent mistakes of human annotators. A reliable automated de-identification system would consequently be of high value. We introduce the first de-identification system based on artificial neural networks (ANNs), which requires no handcrafted features or rules, unlike existing systems. We compare the performance of the system with state-of-the-art systems on two datasets: th...

- by Peter Szolovits
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- Engineering, Electronic Health Records, Humans, Data Anonymization

Recent progression towards precision medicine has encouraged the use of electronic health records (EHRs) as a source for large amounts of data, which is required for studying the effect of treatments or risk factors in more specific subpopulations. Phenotyping algorithms allow to automatically classify patients according to their particular electronic phenotype thus facilitating the setup of retrospective cohorts. Our objective is to compare the performance of different classification strategies (only using standardized problems, rule-based algorithms, statistical learning algorithms (six learners) and stacked generalization (five versions)), for the categorization of patients according to their diabetic status (diabetics, not diabetics and inconclusive; Diabetes of any type) using information extracted from EHRs. Patient information was extracted from the EHR at Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. For the derivation and validation datasets, two probabilistic samples of patients from different years (2005: n = 1663; 2015: n = 800) were extracted. The only inclusion criterion was age (≥40 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;80 years). Four researchers manually reviewed all records and classified patients according to their diabetic status (diabetic: diabetes registered as a health problem or fulfilling the ADA criteria; non-diabetic: not fulfilling the ADA criteria and having at least one fasting glycemia below 126 mg/dL; inconclusive: no data regarding their diabetic status or only one abnormal value). The best performing algorithms within each strategy were tested on the validation set. The standardized codes algorithm achieved a Kappa coefficient value of 0.59 (95% CI 0.49, 0.59) in the validation set. The Boolean logic algorithm reached 0.82 (95% CI 0.76, 0.88). A slightly higher value was achieved by the Feedforward Neural Network (0.9, 95% CI 0.85, 0.94). The best performing learner was the stacked generalization meta-learner that reached a Kappa coefficient value of 0.95 (95% CI 0.91, 0.98). The stacked generalization strategy and the feedforward neural network showed the best classification metrics in the validation set. The implementation of these algorithms enables the exploitation of the data of thousands of patients accurately.

- by Karin Kopitowski and +1
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- Algorithms, Biomedical Engineering, Electronic Health Records, Argentina
- by Harold Luft
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- Cancer, Electronic Health Records, Humans, Biomedical Research
- by M. Bainbridge
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- Engineering, Australia, Electronic Health Records, Humans
- by Tanvir Huda
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- Health Planning, Electronic Health Records, Health Policy, Bangladesh

Numerous information models for electronic health records, such as openEHR archetypes are available. The quality of such clinical models is important to guarantee standardised semantics and to facilitate their interoperability. However, validation aspects are not regarded sufficiently yet. The objective of this report is to investigate the feasibility of archetype development and its community-based validation process, presuming that this review process is a practical way to ensure high-quality information models amending the formal reference model definitions. A standard archetype development approach was applied on a case set of three clinical tests for multiple sclerosis assessment: After an analysis of the tests, the obtained data elements were organised and structured. The appropriate archetype class was selected and the data elements were implemented in an iterative refinement process. Clinical and information modelling experts validated the models in a structured review proce...

- by Martin Boeker
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- Information Systems, Multiple sclerosis, Electronic Health Records, Humans
- by Eswaran Subrahmanian
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- Computer Science, Primary Health Care, Electronic Health Records, Workflow

As the number of healthcare organizations beginning to implement clinical information systems grows, the number of unanticipated and unintentional consequences inevitably increases as well. While existing research suggests that much good can come from clinicians entering orders directly, errors or other unintended consequences related to technology may arise. Ideal for both clinicians and information technology professionals, Clinical Information Systems: Overcoming Adverse Consequences helps fledgling organizations better prepare for the inevitable challenges and obstacles they will face upon the implementation of such systems. Based on the research and findings from the Provider Order Entry Team from the Oregon Health & Science University, this book discusses the nine categories of unintended adverse consequences that occurred at many of the leading medical centers during their implementation and maintenance of a state-of-the-art clinical information system. It goes on to present the best practices they identified to help organizations overcome these obstacles.

Electronic health records are expected to improve the quality of care provided to hospitalized patients. For nurses, use of electronic documentation sources becomes highly relevant because this is where they obtain the majority of necessary patient information. An integrative review of the literature examined the relationship between electronic nursing documentation and the quality of care provided to hospitalized patients. Donabedian's quality framework was used to organize empirical literature for review. To date, the use of electronic nursing documentation to improve patient outcomes remains unclear. Future research should investigate the day-to-day interactions between nurses and electronic nursing documentation for the provision of quality care to hospitalized patients. The majority of U.S. hospital care units currently use paper-based nursing documentation to exchange patient information for quality care. However, by 2014, all U.S. hospitals are expected to use electronic ...

- by Tiffany Kelley
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- Information Technology, Nursing, Informatics, Documentation
- by Greg Alexander
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- Quality of Mental Health Care, Electronic Health Records, Humans, Nursing Homes

The relationship between technological innovations job
market and labor process in several areas have been subject of
intense debate.
From a sociological view, technology incorporates machin-
ery, the physical arrangements of hardware, division of labor
and organization of work built into or required for efficient
operation .
The health sector has been influenced by new technologies.
New machines and equipment, new materials and medicines,
advances in genetics and informatics, and the new information
and communication technologies (ICT) have influenced diag-
nostic and multiple therapeutic procedures. The health
care sector has also been influenced by changes in the orga-
nization of work, in the structure and management of institu-
tions, sometimes accompanied by growth in outsourcing
and precarious employment

- by Jacobs Publishers
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- Genetics, Health Sciences, Informatics, Decision Making