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Chang, Jaime. "Medication concepts, records, and lists in electronic medical record systems." Thesis, Massachusetts Institute of Technology, 2006. http://hdl.handle.net/1721.1/35551.
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Thesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2006.Includes bibliographical references.
A well-designed implementation of medication concepts, records, and lists in an electronic medical record (EMR) system allows it to successfully perform many functions vital for the provision of quality health care. A controlled medication terminology provides the foundation for decision support services, such as duplication checking, allergy checking, and drug-drug interaction alerts. Clever modeling of medication records makes it easy to provide a history of any medication the patient is on and to generate the patient's medication list for any arbitrary point in time. Medication lists that distinguish between description and prescription and that are exportable in a standard format can play an essential role in medication reconciliation and contribute to the reduction of medication errors. At present, there is no general agreement on how to best implement medication concepts, records, and lists. The underlying implementation in an EMR often reflects the needs, culture, and history of both the developers and the local users. survey of a sample of medication terminologies (COSTAR Directory, the MDD, NDDF Plus, and RxNorm) and EMR implementations of medication records (OnCall, LMR, and the Benedum EMR) reveals the advantages and disadvantages of each. There is no medication system that would fit perfectly in every single context, but some features should strongly be considered in the development of any new system.
(cont.) A survey of a sample of medication terminologies (COSTAR Directory, the MDD, NDDF Plus, and RxNorm) and EMR implementations of medication records (OnCall, LMR, and the Benedum EMR) reveals the advantages and disadvantages of each. There is no medication system that would fit perfectly in every single context, but some features should strongly be considered in the development of any new system.
by Jaime Chang.
S.M.
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Sundvall, Erik. "Scalability and Semantic Sustainability in Electronic Health Record Systems." Doctoral thesis, Linköpings universitet, Medicinsk informatik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-87702.
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This work is a small contribution to the greater goal of making software systems used in healthcare more useful and sustainable. To come closer to that goal, health record data will need to be more computable and easier to exchange between systems. Interoperability refers to getting systems to work together and semantics concerns the study of meanings. If Semantic interoperability is achieved then information entered in one information system is usable in other systems and reusable for many purposes. Scalability refers to the extent to which a system can gracefully grow by adding more resources. Sustainability refers more to how to best use available limited resources. Both aspects are important. The main focus and aim of the thesis is to increase knowledge about how to support scalability and semantic sustainability. It reports explorations of how to apply aspects of the above to Electronic Health Record (EHR) systems, associated infrastructure, data structures, terminology systems, user interfaces and their mutual boundaries. Using terminology systems is one way to improve computability and comparability of data. Modern complex ontologies and terminology systems can contain hundreds of thousands of concepts that can have many kinds of relationships to multiple other concepts. This makes visualization challenging. Many visualization approaches designed to show the local neighbourhood of a single concept node do not scale well to larger sets of nodes. The interactive TermViz approach described in this thesis, is designed to aid users to navigate and comprehend the context of several nodes simultaneously. Two applications are presented where TermViz aids management of the boundary between EHR data structures and the terminology system SNOMED CT. The amount of available time from people skilled in health informatics is limited. Adequate methods and tools are required to develop, maintain and reuse health-IT solutions in a sustainable way. Multiple levels of modelling including a fixed reference model and another layer of flexible reusable ‘archetypes’ for domain specific data structures, is an approach with that aim used in openEHR and the ISO 13606 standard. This approach, including learning, implementing and managing it, is explored from different angles in this thesis. An architecture applying Representational State Transfer (REST) to archetype-based EHR systems, in order to address scalability, is presented. Combined with archetyping this architecture also aims at enabling a sustainable way of continuously evolving multi-vendor EHR solutions. An experimental open source implementation of it, aimed for learning and prototyping, is also presented. Manually changing database structures used for storage every time new versions of archetypes and associated data structures are needed is likely not a sustainable activity. Thus storage systems that can handle change with minimal manual interventions are desirable. Initial explorations of performance and scalability in such systems are also reported Graphical user interfaces focused on EHR navigation, time-perspectives and highlighting of EHR content are also presented – illustrating what can be done with computable health record data and the presented approaches. Desirable aspects of semantic sustainability have been discussed, including: sustainable use of limited resources (such as available time of skilled people), and reduction of unnecessary risks. A semantic sustainability perspective should be inspired and informed by research in complex systems theory, and should also include striving to be highly aware of when and where technical debt is being built up. Semantic sustainability is a shared responsibility. The combined results presented contribute to increasing knowledge about ways to support scalability and semantic sustainability in the context of electronic health record systems. Supporting tools, architectures and approaches are additional contributions.Syftet med denna avhandling är ytterst att göra informationssystem som används i hälso- och sjukvård, särskilt patientjournaler, mer användbara och lättarbetade. Om systemen vore lättare att utveckla och underhålla skulle fler resurser kunna läggas på att tillföra nya och mer användarvänliga funktioner. Om journalsystem och datorprogram kan ”begripa” vad olika saker i journalen är och betyder så kan de vara till större hjälp, t.ex. genom att visa bättre patientöversikter och bidra med beslutsstöd. En del i att göra journalinnehållet begripligt och hanterbart för datorer är att använda sig av terminologisystem som t.ex. ICD-10 och SNOMED CT. En annan viktig del är datastrukturerna där man stoppar in text, mätvärden, koderna från terminologisystem etc. De flesta journalsystem har någon sorts mallar som datastrukturer. Projektet openEHR har tagit fram ett sätt att dela specifikationer av datastrukturer mellan olika journalsystem så att man lättare kan dela och återanvända dem och den journaldata som matats in i dem. Dessa specifikationer kallas ”arketyper” och arketyp-metoden beskrivs även i standarden ISO 13606. Om två olika journalsystem använder samma datastruktur, t.ex. med hjälp av samma arketyper, så kan de utväxla patientdata mellan varandra (de uppnår s.k. semantisk interoperabilitet). Begreppet ”Semantic sustainability” definieras i avhandlingen som ett förhållningssätt som är bredare än semantisk interoperabilitet. Det syftar till att möjliggöra långsiktigt hållbar utveckling av semantik (betydelse) i journalsystem och genom att hantera risker och resurser förståndigt. Förhållningssättet baserar sig på forskning och erfarenheter från systemutveckling och hantering av komplexa system och är avsett att stödja beslutsfattare, och de som utvecklar och underhåller journalsystem, relaterade system och strukturer. För att datorsystem ska kunna växa vid ökad användning ,utan att hamna i återvändsgränder avseende prestanda, så bör vissa designprinciper för skalbarhet följas. Avhandlingen presenterar en systemarkitektur baserad på sådana principer och på arketyp-metoden. Denna arkitektur gör det möjligt att bygga system med delsystem från flera olika leverantörer. Skalbarheten i några lagringslösningar redovisas också. Slutligen redovisas prototyper av gränssnitt för patientöversikter och journalläsning.
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Erdil, Nadiye Özlem. "Systems analysis of electronic health record adoption in the U.S. healthcare system." Diss., Online access via UMI:, 2009.
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Thesis (Ph. D.)--State University of New York at Binghamton, Thomas J. Watson School of Engineering and Applied Science, Department of Systems Science and Industrial Engineering, 2009.Includes bibliographical references.
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Reid, Jr Marvin Leon. "Adoption of Electronic Health Record Systems Within Primary Care Practices." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2228.
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Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment.
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Borek, Jarrod. "Managerial Strategies for Maximizing Benefits From Electronic Health Record Systems." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4959.
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In 2009, the U.S. government allocated $27 billion to health care agencies for electronic health records (EHRs) implementation. The increased use of EHR systems is expected to drive down health care costs and increase profits. To meet this anticipated return on investment (ROI), hospital managers need to be able to successfully design, deploy, and manage EHR systems. The purpose of this single case study was to explore organizational management strategies that hospital managers can use to ensure their investments in EHRs meet targeted ROIs and work efficiency goals. The conceptual framework for this study was based on the technology acceptance model. Primary data were collected from a criterion sample of 6 hospital managers with direct experience designing and implementing successful EHRs in a small hospital in the Northeastern United States. Secondary data were collected using public financial records available on the Internet. After cataloging and grouping the raw data, 4 emergent themes were identified: (a) training, (b) the role of organizational management strategies, (c) technological barriers, and (d) ongoing support and maintenance. Findings may contribute to social change through an increase in the quality of patient care and making health care records more accessible to doctors in isolated areas.
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Xin, Zhang. "Distributed Electronic Health Record System based on Middleware." Thesis, Mittuniversitetet, Institutionen för informationsteknologi och medier, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-18947.
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With the fast development of information technology, traditional healthcare is evolving to a more digital and electronic stage. Electronic HealthRecord (EHR) is residents’ basic information and health care relatedinformation conforming to standard. It can not only provide usefulinformation to medical workers, but also exchange resources with otherinformation systems. But with the growing complexity of electronichealth record data sources, it becomes a big challenge to set up a structurewhich allows different types of data sharing and exchanging inmulti-platform applications. It’s even more important to find out amethod to support great amount of users from different applicationplatform to sharing and exchanging data at the same time.In this paper, we proposed a distributed electronic health record systembased on middleware to address the problem. Both permanent and realtimedata should pass through the middleware provided by the system,and will be transformed into standard format for storage. Multi-threadand distributed server group design will let the system be more flexibleand scalable, and will be able to provide service to users concurrently.The system creates a standard data format for data transferring andstorage. All raw data collected from different kinds of sensor system willbe formatted with application programming interface (API) or softwaredevelopment kit (SDK) system provided before upload to the system.Encryption methods are also implemented to ensure data security andprivacy protection.
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Almutiry, Omar Saud. "Data quality assessment instrument for electronic health record systems in Saudi Arabia." Thesis, University of Southampton, 2017. https://eprints.soton.ac.uk/419029/.
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The provision of high quality data is of considerable importance to both business and government; poor data may lead to poor decisions, so quality plays a crucial role. With the proliferation of electronic data collection by businesses and governments, there has arisen a pressing need to assure this quality. This has been recognized by both the private and public sectors, and many initiatives such as the Data Quality Initiative Framework by the Welsh government, passed in 2004, and the Data Quality Act by the United States government, passed in 2002, have been launched to improve it in those countries. At the same time, healthcare is a domain in which the timely provision of accurate, current and complete patient data is one of the most important objectives. Instigation of a so-called Electronic Health Record (EHR), defined as a repository of patient data in digital form that is stored and exchanged securely and is accessible by different levels of authorized users, has been attracting the attention of both research and industry. EHRs allow information regarding a patient’s health to be distributed among heterogeneous information systems. This evolution has added a layer of complexity in data quality, making data quality assurance a challenging issue, as the key barriers to optimal use of EHR data are the increasing quantity of data and their poor quality. Many data quality frameworks have been developed to measure the quality of data in information systems. However, there is no consensus on a rigorously defined set of data quality dimensions. Existing dimensions are usually based on literature reviews, industrial experiences or intuitive understanding and do not take into consideration the nature of e-healthcare systems. Moreover, definitions of these dimensions vary from one data quality framework to another. The aim of this research is to develop a data quality framework consisting of health-relevant dimensions, and data quality measures that help health organisations to enhance the quality of their data. The study provides both subjective and objective measures for assessing the quality of data. An 11-dimensional data quality framework has been developed and confirmed by EHR stakeholders and a group of experts and data consumers. With each dimension, several associated measures have been developed to help an organisation to measure the quality of the data populating their EHR systems. Some issues linked with the measures associated with security-related dimensions have arisen during the confirmation stage. Therefore, these issues were further discussed and reviewed with security experts in order to revise the proposed framework and its measures. Subsequently, a case study was conducted in a large hospital to examine the practicality of the proposed instrument. The instrument was used to help hospitals to assess their data. After that, the usefulness and practicality of the instrument were examined through an evaluation questionnaire distributed to quality assessment team members. Follow-up interviews with senior managers were carried out to discuss the output of the assessment and its practicality. The contribution of this research is the development of a proper data quality framework for EHRs in the context of Saudi Arabia which resulted in 11 health-relevant data quality dimensions. An instrument was also introduced to represent all developed and confirmed measures that assess data population in EHRs.
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Tannan, Ritu. "Acceptance and Usage of Electronic Health Record Systems in Small Medical Practices." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1028.
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One of the objectives of the U.S. government has been the development of a nationwide health information infrastructure, including adoption and use of an electronic health records (EHR) system. However, a 2008 survey conducted by the National Center for Health Statistics indicated a 41.5% usage of the EHR system by physicians in office-based practices. The purpose of this study was to explore opinions and beliefs on the barriers to the diffusion of an ERH system using Q-methodology. Specifically, the research questions examined the subjectivity in the patterns of perspectives at the preadoption stage of the nonusers and at the postadoption stage of the users of an EHR system to facilitate effective diffusion. Data were collected by self-referred rank ordering of opinions on such barriers and facilitators. The results suggested that the postadoption barriers of time, change in work processes, and organizational factors were critical. Although the time barrier was common, barriers of organizational culture and change in work processes differed among typologies of perspectives at the postadoption stage. Preadoption barriers of finance, organizational culture, time, technology, and autonomy were critical. The typologies of perspectives diverged on critical barriers at the preadoptive stage. A customized solution of an in-house system and training is recommended for perspectives dealing with technical and organizational concerns and a web-based system for perspectives concerned with barriers of finance, technology, and organization. The social impact of tailoring solutions to personal viewpoints would result in the increased sharing of quality medical information for meaningful decision making.
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Chen, Rong. "Towards interoperable and knowledge-based electronic health records using archetype methodology /." Linköping : Department of Biomedical Engineering, Linköpings universitet, 2009. http://www.bibl.liu.se/liupubl/disp/disp2009/tek1280s.htm.
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San, Jose Rhoda Lynn Atienza. "Educating Nurses on Workflow Changes from Electronic Health Record Adoption." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3321.
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Workflow issues related to adoption of the electronic health record (EHR) has led to unsafe workarounds, decreased productivity, inefficient clinical documentation and slow rates of EHR adoption. The problem addressed in this quality improvement project was nurses' lack of knowledge about workflow changes due to EHR adoption. The purpose of this project was to identify changes in workflow and to develop an educational module to communicate the changes. This project was guided by both the ADDIE model (analysis, design, development, implementation, and evaluation) and the diffusion of innovations theory. Five stages were involved: process mapping, cognitive walkthrough, eLearning module development, pilot study, and evaluation. The process maps and cognitive walkthrough revealed significant workflow changes particularly in clinical practice guidelines, emergency department treatment plan, and the interdisciplinary care plan. The eLearning module was developed to describe workflow changes using gamification, scenario-based learning, and EHR simulation. The 14-item course evaluation included a 6-point Likert scale and closed- and open-ended questions. A purposive sample of nurses (N = 30) from the emergency department and inpatient care areas were invited to complete the eLearning module and course evaluation. Data were collected until saturation was achieved (n = 15). Descriptive statistics revealed the participants' positive learning experience. This quality improvement project is expected to contribute to positive social change by facilitating the effective use of the new EHR which can improve the quality of patient care, promote patient safety, reduce healthcare costs, and improve patient outcomes.
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Alhaqbani, Bandar Saleh. "Privacy and trust management for electronic health records." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/37635/1/Bandar_Alhaqbani_Thesis.pdf.
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Establishing a nationwide Electronic Health Record system has become a primary objective for many countries around the world, including Australia, in order to improve the quality of healthcare while at the same time decreasing its cost. Doing so will require federating the large number of patient data repositories currently in use throughout the country. However, implementation of EHR systems is being hindered by several obstacles, among them concerns about data privacy and trustworthiness. Current IT solutions fail to satisfy patients’ privacy desires and do not provide a trustworthiness measure for medical data. This thesis starts with the observation that existing EHR system proposals suer from six serious shortcomings that aect patients’ privacy and safety, and medical practitioners’ trust in EHR data: accuracy and privacy concerns over linking patients’ existing medical records; the inability of patients to have control over who accesses their private data; the inability to protect against inferences about patients’ sensitive data; the lack of a mechanism for evaluating the trustworthiness of medical data; and the failure of current healthcare workflow processes to capture and enforce patient’s privacy desires. Following an action research method, this thesis addresses the above shortcomings by firstly proposing an architecture for linking electronic medical records in an accurate and private way where patients are given control over what information can be revealed about them. This is accomplished by extending the structure and protocols introduced in federated identity management to link a patient’s EHR to his existing medical records by using pseudonym identifiers. Secondly, a privacy-aware access control model is developed to satisfy patients’ privacy requirements. The model is developed by integrating three standard access control models in a way that gives patients access control over their private data and ensures that legitimate uses of EHRs are not hindered. Thirdly, a probabilistic approach for detecting and restricting inference channels resulting from publicly-available medical data is developed to guard against indirect accesses to a patient’s private data. This approach is based upon a Bayesian network and the causal probabilistic relations that exist between medical data fields. The resulting definitions and algorithms show how an inference channel can be detected and restricted to satisfy patients’ expressed privacy goals. Fourthly, a medical data trustworthiness assessment model is developed to evaluate the quality of medical data by assessing the trustworthiness of its sources (e.g. a healthcare provider or medical practitioner). In this model, Beta and Dirichlet reputation systems are used to collect reputation scores about medical data sources and these are used to compute the trustworthiness of medical data via subjective logic. Finally, an extension is made to healthcare workflow management processes to capture and enforce patients’ privacy policies. This is accomplished by developing a conceptual model that introduces new workflow notions to make the workflow management system aware of a patient’s privacy requirements. These extensions are then implemented in the YAWL workflow management system.
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Miller, Shaunette. "Strategies Hospital Leaders Use in Implementing Electronic Medical Record Systems." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3311.
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Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter's (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring codes exhibiting high frequencies to identify principal themes and subthemes. The data coding revealed three primary themes. The first theme related to strategies addressing training, technology, and catalyzing team effort. The second theme related to strategies focusing on employees' concerns, and the third theme related to strategies for designing, developing, and disseminating workflow. The findings affirmed the conceptual framework of Kotter (1996) inasmuch as they showed that participating hospital leaders used one or more steps in Kotter's eight-stage process of creating, implementing, and sustaining significant change. The findings could effect social change by improving the quality of healthcare services provided to patients, which can subsequently benefit patients' families and communities through reducing the costs of healthcare.
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Weagraff, Joseph B. "Health Care Leaders' Experiences of Electronic Medical Record Adoption and Use." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3216.
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Adoption of electronic medical record (EMR) technology systems of meaningful use has been slow despite the mandate by the U.S. government. The purpose of this single case study was to explore strategies used by health care leaders to implement EMR technology systems of meaningful use to take advantage of federal incentive payments. Diffusion of innovation theory provided the conceptual framework for the study. Semistructured interviews were conducted with 6 health care leaders from a military installation in the Southeast United States. Data were analyzed using software, coding, and inductive analyses. The 3 prominent themes were patient, provider, and champion. Alerts from an EMR technology system can increase providers' awareness and improve patient safety. Providers' involvement in every phase of an EMR system's implementation can improve the adoption rate. Champions play a critical role in successful adoption and implementation of EMR systems. Results of this study may assist health care leaders in implementing EMR systems to take advantage of federal incentive payments. Implications for positive social change include enhanced delivery of safe, high-quality health care.
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Barnawi, Abdullah. "Risk management of electronic health record system in hospitals." Thesis, De Montfort University, 2013. http://hdl.handle.net/2086/10411.
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This thesis investigates the use of electronic medical record (EMR) systems and risk management in hospitals. It provides a critical analysis of recognized EMR systems and potential failures and discusses six traditional risk management techniques including brain storming, cause, effect analysis, failure mode effective analysis (FMEA), fault tree analysis (FTA), and Binary Decision Diagram (BDD) in addition, to one of the most recent systematic risk management techniques, Systems Theoretic Accident Model Process (STAMP). The traditional techniques are not as well suited to managing risks and preventing failures in modern information systems with complex software that involves human and machine interaction. The thesis introduces the implementation of common traditional risk management technique such as BDD and FTA which is mostly used in nuclear plants, transportation and medical devices backed by a hypothetical example to help and explain the process of the FTA usage. Most traditional techniques rely on a direct cause-and-effect chain and have no clear formal guidance. The systematic technique introduced and used in this study, is known as Systems Theoretic Accident Model Process (STAMP). It is one of the recent systematic techniques developed and used in many sectors including aerospace. This study applied the STAMP technique to the EMR system failure at King Khalid General Hospital (KKGH) in Riyadh. One of the reasons for selecting the STAMP technique is that it is based on system theory and established the risk factors that lead to system failure. It also provides guidance for managing and controlling risk factors. This thesis discusses the implementation of STAMP, supported by examples, to explain how the technique conducted. System failures occur unexpectedly and have the potential to affect health services; they can compromise patient health and sometimes lead to death. The aims of this study are to explore The Kingdom of Saudi Arabia healthcare usage of EMRs and risk factors that leads to system failure and demonstrate the benefit of STAMP for RM in EMR system, define gaps and provide suggestion based on international best practice The study was conducted in three phases. The first phase explored EMR system usage and failures. The second phase implemented the STAMP risk management technique at one hospital of our 8 surveyed hospitals, the King Khalid General Hospital’s (KKGH), to identify and manage risks. In the third phase, the study modified the STAMP technique and reapplied it. The modified technique STAMP Checklist (STAMPC) was compared with the original STAMP technique. We found that STAMPC is much more usable and subjectively beneficial for the hospital that uses a hybrid system. Data extracted using the modified technique provided more useful information to improve EMR system safety, and prevent potential failures. This study addresses the challenges of how effectively RM techniques used to reduce the potential risk of EMR system failures in hospitals. It improves the efficiency of the STAMP risk management technique by proposing a new (STAMPC) technique. There are 3 important implications for both RM and EMRs practice: first, the study suggests that RM and EMRs are integral parts of the management decision-making process; second, they are necessary to improve human health and safety; and, third, RM may minimise the possibility of system failure.
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Malta, André Filipe Domingues. "Open-source electronic health record system for neglected diseases." Master's thesis, Universidade de Aveiro, 2016. http://hdl.handle.net/10773/18342.
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Mestrado em Engenharia de Computadores e TelemáticaLow-resource countries are primarily the ones afected by tropical diseases where environmental factors play a major role. Means for controlling these diseases are often lacking in these countries in part due to their poor support of Health Information Technology. Nowadays, with the advances of standards and software in the health-field, several open-source electronic health record systems (EHR) exist which can assist facilities to capture of information, aiding to research and better health-care of neglected diseases in these countries. In this work, we performed a systematic review of several of such solutions to select the most appropriate candidate to satisfy the requirements of a testbed in a low-resource country - Gondar in Ethiopia. The implementation was conducted with a strong focus on adapting the existing paper-based workflow of the institution to the proposed system, to assure that all the information generated in this center can be captured in a digital way. As a final result, a working prototype was deployed and some conclusions are obtained from all this process.
Países sub-desenvolvidos são os principalmente afectados por um conjunto de doenças tropicais onde factores ambientais desempenham uma contribuição maior na sua origem. No geral estes países não dispõem de métodos para controlar estas doenças eficazmente, em parte devido à fraca implementação de Tecnologias da Informação em Saúde. Atualmente, com o avanço em standards e software na área da saúde, existem diversos sistemas opensource de registos clínicos que podem auxiliar centros de cuidados médicos na captura de informação útil à melhoria dos serviços prestados e há investigação de doenças negligenciadas. Nesta dissertação efectuámos uma revisão sistemática de tais soluções de maneira a escolher um candidato apropriado aos requisitos de uma cama de teste de um país sub-desenvolvido - Gondar, Etiópia. A implementação foi conduzida com ênfase à adaptação do fluxo de trabalho baseado em papel da instituição para o sistema proposto, assegurando que toda a informação gerada pelo centro pode ser capturada de forma digital. Como resultado final, um protótipo foi criado e algumas conclusões obtidas de todo este processo.
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Win, Khin Than. "The application of the FMEA risk assessment technique to electronic health record systems." Access electronically, 2005. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20050822.093730/index.html.
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Mohammad, Yara Mahmoud. "Information security strategy in telemedicine and e-health systems : a case study of England’s shared electronic health record system." Thesis, Brunel University, 2010. http://bura.brunel.ac.uk/handle/2438/4669.
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Shared electronic health record (EHR) systems constitute an important Telemedicine and e-Health application. Successful implementation of shared health records calls for a satisfactory level of security. This is invariably achieved through applying and enforcing strict, and often quite complicated, rules and procedures in the access process. For this reason, information security strategy for EHR systems is needed to be in place. This research reviewed the definition of different terms that related to electronically stored and shared health records and delineated related information security terms leading to a definition of an information security strategy. This research also made a contribution to understanding information security strategy as a significant need in EHR systems. A major case study of the National Programme for IT (NPfIT) in England is used to be the container of other two sub-case studies in two different Acute Trusts. Different research methods used: participant observation and networking, semi-structured interviews, and documentary analysis. This research aimed to provide a comprehensive understanding to the information security strategy of England’s EHR system by presenting its different information security issues such as consent mechanisms, access control, sharing level, and related legal and regulatory documents. Six factors that influence the building of an information security strategy in EHR systems, were identified in this research, political, social, financial, technical, clinical and legal. Those factors are considered to be driving the strategy directly or indirectly. EHR systems are technical-clinical systems, but having other factors (than technical and clinical) that drive this technical-clinical system is a big concern. This research makes a significant contribution by identifying these factors, and in addition, this research shows not only how these factors can influence building the information security strategy, but also how they can influence each other. The study of the mutual influence among the six factors led to the argument that the most powerful factor is the political factor, as it directly or indirectly influences the remaining five factors. Finally, this research proposes guidelines for building an information security strategy in EHR systems. These guidelines are presented and discussed in the form of a framework. This framework was designed after literature analysis and after completing the whole research journey. It provides a tool to help putting the strategy in line by minimising the influence of various factors that may steer the strategy to undesirable directions.
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Adetayo-odepidan, Mojeed. "Electronic Health Record Systems : A study of privacy in the region Kronoberg of Sweden." Thesis, Linnéuniversitetet, Institutionen för informatik (IK), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-60198.
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This study gives a brief description of paper-based record and the adoption of ICT, which brought the introduction of Electronic Health Record System (EHRS) in Sweden, the challenges facing EHR in the health care sector around the world and what immigrants and newcomers who just arrived in Sweden knows about the privacy, rights and the policies that protect their privacy and data system, these could cause them not having enough confidence in electronic health record system, they could also be worried about their information been exposed or disclosed by their healthcare providers, this call for the confidentiality, security and privacy of EHR System. The aim of this study is to explore immigrants and newcomers as users of electronic health record system by setting interview questions and focus group to help the researcher to understand their knowledge of what they know about the privacy of EHRS and what they know about the policies health care providers follow to protect patient’s privacy and data. It is very important for them to know their rights and the rights that protect their privacy and data from been shared or disclosed. The study also talked about the existing implications facing EHRs, comparison of both systems was shown in table 1 of this study. The necessity for a proper protection of patient data was discussed and recommendation was made towards having a great and a working electronic health record system.
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Sparks, Rox Ann. "Improving Workflow at the Point of Care Using the Electronic Health Record." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3635.
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The electronic health record (EHR) is an important part of the effort to improve health care and reduce costs in the United States. Primary care providers, among the largest group of caregivers in the nation, often experience difficulty with implementation and utilization of EHRs. Efforts to enhance the provider's effectiveness in the use of the EHR should result in improved patient outcomes as well as decreasing the overall cost of health care. Guided by the diffusion of innovation theory, this project was initiated to develop a plan for improved usage of the EHR in a primary care setting. A survey and observations were used to better understand how the providers and staff were using the EHR. Observations and a survey of 11 participants were completed. The observations utilizing a mock patient revealed issues related to the usability of screen information, information availability, and user preference for documentation. The mock patient scenario took 25-35 minutes, on average, to complete. All participants stated they had stayed late to input information on actual clinic patients or to clarify their documentation. The same 11 participants completed the Primary Care Information Project (PCIP) Post-Electronic Health Record Implementation: Survey of Providers responses. Descriptive statistics were used to analyze the results. Most participants indicated that the screen font was difficult to read (72.7%), they had difficulty using the EHR (72.8%) and were not satisfied with its use (63.6%). The project recommendations include working with the vendor to improve information access and ongoing training. Improvements to the EHR should support social change by improving access to information at the point of care, enhancing quality treatment and improving patient care outcomes.
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Richardson, Daniel. "The Successful Implementation of Electronic Health Records at Small Rural Hospitals." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2375.
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Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement EHRs. The focus of this descriptive phenomenological study was to explore lived experiences of hospital leaders and administrators who have used successful strategies to implement EHRs in small rural hospitals. Diffusion of innovation theory shaped the theoretical framework of this study. Data were collected through telephone interviews conducted with participants who successfully deployed EHRs at 10 hospitals in the Appalachian regions of Maryland, Virginia, and West Virginia. Data analysis occurred using a modified Husserlian approach in search of common themes from interview transcripts. The main themes were strategies to address standards and incentives, implementation, and challenges. The exploration of these strategies provides insight that small rural hospital leaders and administrators could consider for implementing EHRs. The study findings might enable small rural hospital leaders and administrators to contribute to positive social change by engaging communities in using EHRs; these findings may also expand information sharing among individuals and organizations and build social relationships with an expectation of future benefits. Results from this study are designed to inform other small rural hospital leaders and administrators to conduct further research on successful strategies for implementation of EHRs.
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Gray, C. J. "Electronic health record systems in a centralized computing services environment| critical success factors for implementation." Thesis, Robert Morris University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3628910.
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In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve meaningful use. Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a cloud-based EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a cloud or cloud-based environment.
This study found that the top five critical success factors for the implementation were the following: (1) EHR Training – implementing a strong training / education process for EHR users; (2) Usability – practical application of EHR features in a real medical office setting; (3) Reliability – Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.
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Tokunaga, Tatsuya. "A Web Application Framework Facilitates Multiple Use of Medical Information on Electronic Health Record Systems." 京都大学 (Kyoto University), 2013. http://hdl.handle.net/2433/174840.
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Gargett, Ross. "The Use of Automated Speech Recognition in Electronic Health Records in Rural Health Care Systems." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/honors/340.
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Since the HITECH (Health Information Technology for Economic and Clinical Health) Act was enacted, healthcare providers are required to achieve “Meaningful Use.” CPOE (Clinical Provider Order Entry), is one such requirement. Many providers prefer to dictate their orders rather than typing them. Medical vocabulary is wrought with its own terminology and department-specific acronyms, and many ASR (Automated Speech Recognition) systems are not trained to interpret this language.
The purpose of this thesis research was to investigate the use and effectiveness of ASR in the healthcare industry. Multiple hospitals and multiple clinicians agreed to be followed through their use of an ASR system to enter patient data into the record. As a result of this research, the effectiveness and use of the ASR was examined, and multiple issues with the use and accuracy of the system were uncovered.
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Koppenhaver, II Kenneth E. "Effects of an Integrated Electronic Health Record on an Academic Medical Center." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2666.
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The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and technology factors that change as a result of an EHR implementation. Complexity theory was used as the lens to evaluate the effects of the EHR on the holistic system of healthcare. Data were collected using semistructured interviews and observations of physicians, nurses, and administrators, as well as document reviews of organizational documents related to the EHR. Data were analyzed using open coding to identify themes and patterns of usage that redesign or restructure institutional resources. The results of this study demonstrated positive changes in the interactions of healthcare providers with increasing collaboration on process changes and reliance on EHR for communication. These findings may positively affect government policy and the organizational approach to adoption and ongoing use of EHRs to create organizational change beyond the implementation of such systems, thus benefiting both health care employees and patients.
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Ganju, Kartik Krishna. "The Unintended Consequences of the Adoption of Electronic Medical Record Systems on Healthcare Costs." Diss., Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/382515.
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Business Administration/Management Information SystemsPh.D.
In my dissertation, I study unintended consequences of the adoption of EMR systems. In my three essays, I examine how the adoption of EMR systems affects neighboring hospitals (spillover effects), can be used by hospitals to further its objectives in an unconventional manner (“upcoding” of patient case mix data), and how EMR adoption may end in the eventual abandonment of the system along with corresponding negative effects. In my first essay, I examine if the adoption of EMR systems has effects beyond the adopting hospital to neighboring hospitals. I find that the adoption of these systems has “spillover” effects to neighboring hospitals and that although the adoption of EMR systems leads to an increase in the operating cost of the adopting hospital, spillover effects reduce the operational cost of neighboring hospitals. In the second essay of my dissertation, I examine if an unintended consequence of the adoption of EMR systems is that there could be an increase in “upcoding” activities by hospitals. Upcoding deals with patients being diagnosed in such a manner as to increase the reimbursement of hospitals by inappropriately increasing the patient’s case mix. Using the roll-out of an auditing program as a natural experiment, I find that there is evidence to suggest upcoding by hospitals, particularly by for-profit hospitals. Finally, in the third essay of my dissertation, I examine the phenomenon of abandonment of EMR systems and find that the abandonment of EMR system leads to an increase in the operational cost of hospitals. I also examine which hospitals are more likely to abandon their EMR systems both outside and during the HITECH Act. I argue that the adoption of EMR systems often has unanticipated and unintended consequences.
Temple University--Theses
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Perry, Alexander. "Exploring User Interfaces for Search and Content Based Clinical Decision Support in Electronic Health Record Systems." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for datateknikk og informasjonsvitenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-23164.
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Both electronic health records (EHR) and clinical decision support (CDS)are each important attributions to clinicans and clinical workflow. Elec-tronic health records provide clinicans with crucial patient information atthe point of care, while clinical decision support gives well-founded and well-documented clinical recommendations at the point of decision making.This thesis explores how patient information from EHRs could be utilized as abasis for better and more effective decision support. Additionally, two meth-ods of accessing decision support recommendations are created and studied.One is based on search, with known elements from common general andmedical search interfaces. The other performs automatic ranking of relevantrecommendations based on patient information from a popular norwegianEHR system.To find out how these two prototypes should integrate and utilize informa-tion from an EHR system, an case-based experiment was conducted. Thisis a qualitative measure of user feedback, with elements from quantitativeresearch. User satisfaction were measured by using methods such as usertesting, interviews and surveys.User feedback suggest that clinical workflow have much to gain from integrat-ing EHR with CDS, as well as computerizing and making clinical nationalrecommendations available in an EHR context. It is also clear that elementslike search and automation are important features in an integrated system,and further research of decision support may include an integration of theseelements.
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Ngunyu, Daniel Kanyi. "Strategies for Applying Electronic Health Records to Achieve Cost Saving Benefits." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5236.
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The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the distribution of about $30 billion incentive funds to accelerate electronic health record (EHR) applications to improve the quality of care, safety, privacy, care coordination, and patients' involvement in healthcare. EHR use has the potential of saving $731 in costs for hospitals per patient admission; however, most hospitals are not applying EHR to reach the level at which cost savings are possible. The purpose of this single case study was to explore strategies that IT leaders in hospitals can use to apply EHR to achieve the cost saving benefits. The participants were IT leaders and EHR super users at a large hospital in Texas with successful experience in applying EHR. Information systems success model formed the conceptual framework for the study. I conducted face-to-face interviews and analyzed organizational documents. I used qualitative textual data analysis method to identify themes. Five themes emerged from this study, which are ensuring information quality, ensuring system quality, assuring service quality, promoting usability, and maximizing net benefits of the EHR system. The findings of this study included four strategies to apply EHR; these strategies include engaging training staff, documenting accurately and in a timely manner, protecting patient data, and enforcing organizational best practice policies to maximize reimbursement and cost savings. The findings of this study could contribute to positive social change for the communities because EHR successful application includes lower cost for hospitals that may lead to the provision of affordable care to more low-income patients.
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Huang, Jiawei. "The Road to a Nationwide Electronic Health Record System: Data Interoperability and Regulatory Landscape." Scholarship @ Claremont, 2019. https://scholarship.claremont.edu/cmc_theses/2224.
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This paper seeks to break down how a large scale Electronic Health Records system could improve quality of care and reduce monetary waste in the healthcare system. The paper further explores issues regarding regulations to data exchange and data interoperability. Due to the massive size of healthcare data, the exponential increase in the speed of data generation through innovative technologies, and the complexity of healthcare data types, the widespread of a large-scale EHR system has hit barriers. Much of the data available is unstructured or contained within a singular healthcare provider’s systems. To fully utilize all the data available, methods for making data interoperable and regulations for data exchange to protect and support patients must be made. Through angles addressing data exchange and interoperability, we seek to break down the constraints and issues that EHR systems still face and gain an understanding of the regulatory landscape.
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Källgren, Robert. "Implementing and evaluating an unconventional design of an electronic health record system." Thesis, Uppsala universitet, Institutionen för informationsteknologi, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-420657.
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As the digitisation of healthcare progresses, there are still problems in terms of usability. With the goal of exploring solutions to these, an email inspired design for an electronic health record system was implemented using modern web technologies. The implementation was then evaluated in a series of usability tests conducted with five orthopaedic surgeons. Participants were asked to perform small tasks on a mocked data set, and the sessions were concluded with debriefing interviews. The focus was on the areas that are new in this design. The results suggest that the general design works, and no critical flaws were identified at this stage. Most of the issues that were found are likely to be solved with more training and experience, but there is still room for improvement. Participants had positive reactions overall, and plenty of feedback was collected regarding areas of improvement and feature suggestions. Due to the limitations of the test, the findings mostly relate to the intuitiveness of the design. To draw stronger conclusions regarding the viability of the design in a real environment, further testing with more data, realistic test tasks and more prerequisite training is necessary.Digitiseringen inom sjukvården ökar, men det finns fortfarande problem när det kommer till användbarheten av de digitala system som finns på marknaden. Med målet att utforska lösningar på dessa problem implementerades i detta arbete en e-post-inspirerad gränssnittsdesign för ett digitalt journalsystem med hjälp av moderna webb-teknologier. Implementationen utvärderades genom användartester där fem ortopediska kirurger deltog. Deltagarna ombads använda gränssnittet för att utföra små testuppgifter med påhittad patientdata, och sessionerna avslutades med intervjufrågor. Fokuset var på de delar som är nya i den här designen jämfört med redan existerande system. Resultatet visar att det generella upplägget fungerar, och inga kritiska brister upptäcktes i detta stadie. De flesta av problemen som uppdagades kan troligen lösas genom att användarna ges möjlighet till mer träning och får mer erfarenhet, men det finns fortfarande förbättringutrymme. Deltagarna hade positiva reaktioner i allmänhet, och många förslag kring förbättringsområden och önskemål kring utökad funktionalitet samlades upp. På grund av användartestets begränsningar belyser resultaten i detta test mest vilka delar av gränssnittet som är intuitiva eller ej, medan det som är mer intressant för den här typen av dagligen använda system egentligen är huruvida de är effektiva att använda i det dagliga arbetet. För att kunna dra säkrare slutsatser kring om den här designen skulle fungera i riktiga arbetssituationer behövs mer testning med större mängder patientdata, mer realistiska testuppgifter och mer tid för deltagarna att lära sig systemet i förväg.
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Perumal, Palani. "Business model and strategy analysis for radiologists to use electronic health records (EHR)." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/76928.
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Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2012.Cataloged from PDF version of thesis.
Includes bibliographical references (p. 90-94).
Radiology is a medical specialty that employs imaging to diagnose and treat disease. It has long been an advance user of technology to capture, store, share, and use images electronically. In 2009, President Obama signed into law a measure, the HITECH Act (part of the stimulus package), that incentivizes healthcare providers to use electronic health records (EHR) in care delivery to improve quality, efficiency, safety, and reduce cost. The meaningful use (MU) program's Stage 1 requirements (part of HITECH Act) did not include imaging requirements, leading to confusion among radiologists and other specialties with regard to what MU offers to and requires of them. This thesis attempts to clarify the contribution radiology can make to MU by understanding radiology as a system, including its surrounding issues and its drivers, using Stage 1 MU requirements, data from qualitative research, and results from analysis. It answers the following question: Should Radiologists be considered part of the care team, leveraging EHR for meaningful use and hence eligible for incentive payments? It does so via the following methods: a) Discussing in detail current issues surrounding radiology systems from quality, safety, efficiency, and cost perspectives; b) Discussing MU in the context of radiology and reviewing what is missing in it for radiologists; c) Providing deeper systems analysis of current behaviors and why they have this form at this time; and d) Explaining how MU objectives can help to overcome many current issues and ultimately help to improve health outcomes. Specific changes to MU criteria to achieve these benefits are recommended. This thesis employs systems concepts and tools including system architecture and system dynamics for research and analysis to understand the system and derive hypotheses. A system dynamics model is used to analyze current drivers in imaging and to clarify the impact MU can have on these drivers. Thesis conclusions are supported by the analysis performed using the model as well as information gathered through industry interviews, online articles, academic and industry journals, and blogs.
by Palani Perumal.
S.M.in Engineering and Management
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Chan, Hok Ki. "Electronic Health Record Sharing System in Hong Kong : Facilitating and Impeding Factors Influencing Citizens' Adoption." Thesis, Linnéuniversitetet, Institutionen för informatik (IK), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-105690.
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This study is a qualitative research on the faciliating and impeding factors that influence Hong Kong citizen's adoption of Electronic Health Record Sharing System (eHRSS), the principal electronic health record (EHR) system in Hong Kong. A majority of the previous studies of EHR among information systems (IS) literature either focused within the institutional or technological perspectives, or on the perspectives of healthcare institutions or healthcare professionals. Little research has been done from citizens' perspective on factors of their adoption of EHR. There is also little research specific to Hong Kong's circumstances. This research aims to provide an enhanced understanding on the factors that influence citizens' EHR adoption through looking into eHRSS adoption in Hong Kong. It aims to provide contributions to bridge the knowledge gaps by providing a better understanding on adoption factors from citizens' perspective, and investigate into whether there are any unique factors applicable to Hong Kong. In this study, semi-structured interviews had been performed on participants covering various age groups to collect their views and opinions concering their adoption of eHRSS. With reference to theoretical constructs on user acceptance and adoption, this study identifies four facilitating factors for citizens' adoption of eHRSS, namely (i) knowledge, (ii) trust, (iii) perceived potential health benefits and (iv) flexibility and "stickiness" of continual use. Four impeding factors for citizens' non-adoption were also identified, namely (i) difficulty in registration, low level/lack of trust in EHR implementation, (iii) negativity on acceptance of new technology and (iv) perceived difficulty in usage. In the concluding remarks, way forward for future research has been outlined. Practical recommendations have also been formulated for reference by relevant authorities in administering eHRSS in Hong Kong.
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Alexander, Gregory Lynn. "Human factors, automation, and alerting mechanisms in nursing home electronic health records." Diss., Columbia, Mo. : University of Missouri-Columbia, 2005. http://hdl.handle.net/10355/4128.
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Thesis (Ph. D.)--University of Missouri-Columbia, 2005.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "July 2005." Includes bibliographical references.
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Lin, Yu-Kai. "Health Analytics and Predictive Modeling: Four Essays on Health Informatics." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/555987.
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There is a marked trend of using information technologies to improve healthcare. Among all the health IT, electronic health record (EHR) systems hold great promises as they modernize the paradigm and practice of care provision. However, empirical studies in the literature found mixed evidence on whether EHRs improve quality of care. I posit two explanations for the mixed evidence. First, most prior studies failed to account for system use and only focused on EHR purchase or adoption. Second, most existing EHR systems provide inadequate clinical decision support and hence, fail to reveal the full potential of digital health. In this dissertation I address two broad research questions: a) Does meaningful use of EHRs improve quality of care? and b) How do we advance clinical decision making through innovative computational techniques of healthcare analytics? To these ends, the dissertation comprises four essays. The first essay examines whether meaningful use of EHRs improve quality of care through a natural experiment. I found that meaningful use significantly improve quality of care, and this effect is greater in historically disadvantaged hospitals such as small, non-teaching, or rural hospitals. These empirical findings present salient practical and policy implications about the role of health IT. On the other hand, in the other three essays I work with real-world EHR data sets and propose healthcare analytics frameworks and methods to better utilize clinical text (Essay II), integrate clinical guidelines and EHR data for risk prediction (Essay III), and develop a principled approach for multifaceted risk profiling (Essay IV). Models, frameworks, and design principles proposed in these essays advance not only health IT research, but also more broadly contribute to business analytics, design science, and predictive modeling research.
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Harper, Sherhonda Yvette. "Public Health Providers' Perceptions of Electronic Health Records in a Disaster." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4634.
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The introduction of federal initiatives and incentives regarding health information technology fostered a movement towards the adoption of electronic health records (EHR). Implementation of EHRs sparked discussions among healthcare providers, patients, and others about the benefits or challenges of the move from the traditional paper method to the electronic version in healthcare settings. A knowledge gap in research involving the usefulness of EHRs and their impact to the delivery of care in other settings exists. The purpose of this qualitative study was to explore public health providers' perceptions of the meaningful use of EHRs in a disaster setting. Study participants were public health providers from Louisiana recruited via criterion sampling and snowball sampling. A qualitative, phenomenological design was used to gain understanding of the public health providers' experiences with and perceptions of EHRs in a disaster setting. Data were collected from 7 public health providers using in-depth interviews and reflective journal notes. The data were analyzed for patterns and themes using the hermeneutic circle method. The study findings indicate that individuals want to be involved in designing their system and adjusting workflow in the workplace setting. The majority of participants concluded that EHR systems are beneficial in the disaster setting, but there were no impacts to improving health outcomes. The findings provide policymakers, public health departments, healthcare providers, emergency managers, and communities needed information on the potential impact of EHRs in the disaster setting on improving safe and effective care.
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Lee, Koon-hung, and 勵冠雄. "Communicating patients' medical information by online electronic health record system: physicians anddentists' perception." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971933.
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Mason, Patricia Lynn. "Diffusion of Electronic Health Records in Rural Primary Care Clinics." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/466.
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By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants' experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices.
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Tokosi, Temitope Oluwaseyi. "Electronic patient record (EPR) system in South Africa : information, storage, retrieval and share amongst clinicians." University of the Western cape, 2016. http://hdl.handle.net/11394/5414.
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Philosophiae Doctor - PhDA phenomenological philosophy underlies this research study which attempts to understand clinicians’ perception and understanding of an electronic patient record (EPR) system currently operational at a hospital in the Western Cape Province in South Africa (SA). Healthcare is a human right, thus patient records contain critical data and mostly paper-based in many SA hospitals. Clinicians are the EPR primary users and their attitude in its use is important for its success. This study explores, identifies and determines clinicians’ cognitive attributes towards EPR with a technology use framework developed. An initial quantitative approach was applied but unsuccessful due to low sample size. A pilot study was then conducted using 11 respondents. Purposive sampling was first initiated then snowball introduced later to improve the sample size qualitatively. Interviews were administered to 15 clinicians and tape recorded. Narrative content analysis was used as the preferred analysis technique because of the advantage of gaining direct information from study participants, unobtrusive and a nonreactive way to study the phenomenon of interest. Research findings tested 12 propositions and found high impact relationships between attitude (ATT) and each listed theme namely: perceived usefulness (PU), perceived ease of use (PEOU), complexity (COM), facilitating condition (FC), use behaviour (USE). Use behaviour had high impact relationships with storage (STO) and retrieval (RET). There were moderate impact relationships between PU and USE; PEOU and PU; RA and ATT; job fit (JF) and ATT; USE and share (SHA). The implication here is that any EPR system to be implemented should be tested using this framework to ascertain its usefulness and fit with a hospital's objectives and users expectations. By so doing, anticipated problems can be mitigated against and resolved before implementation. The study contributes to the information system (IS) body of knowledge through the technology use framework. The framework is for adoption by hospital management and its use by clinicians where EPR is operational. Traditional IS frameworks can be adopted for hospitals about to implement EPR because of the relevance of the "intent to use" theme.
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Richardson, Tony Andrew. "Meeting Meaningful-Use Requirements With Electronic Medical Records in a Community Health Clinic." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2872.
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Small nonprofit medical practices lack the technical expertise to implement electronic medical records (EMRs) that are consistent with federal meaningful-use requirements. Failure to comply with meaningful-use EMR requirements affects nonprofit community health care leaders' ability to receive reimbursement for care. Complexity theory was the conceptual framework used in this exploratory single case study. The purpose of the study was to explore the strategies nonprofit community health care leaders in Washington, DC used to implement EMRs in order to comply with the meaningful-use requirements. Data were collected via in-depth interviews with 7 purposively-selected health care leaders in a nonprofit clinic and were supplemented with archival records from the organization's policies and legislated mandates. Participants' responses were coded into invariant constituents, single concepts, and ideas to develop theme clusters. Member checking was used to validate the transcribed data which was subsequently coded into 4 themes that included: access to information, quality of care, training, and reporting implications. Recommendations include increased effectiveness of training provided to health care leaders or the perceptions of the patients as stakeholders in EMR implementation. By using strategies that facilitate seamless movement of information within a digital health care infrastructure, business leaders could benefit from improved reimbursement for services. Implications for social change include progress and transformation in the way health care access is provided.
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Sharma, Urvashi. "Understanding the processes of information systems deployment and evaluation : the challenges facing e-health." Thesis, Brunel University, 2011. http://bura.brunel.ac.uk/handle/2438/6096.
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Information Systems (IS) innovations in healthcare sector are seen as panacea to control burgeoning demand on healthcare resources and lack of streamlining in care delivery. Two particular manifestations of such innovations are telehealth and electronic records in its two forms: the electronic medical records and the electronic health records. Deployment efforts concerning both of these IS-innovations have encountered a rough terrain and have been slow. Problems are also faced while evaluating the effectiveness of innovations on health and care delivery outcomes through strategies such as randomised controlled trials- particularly in case of telehealth. By taking these issues into account, this research investigates the issues that affect IS innovation deployment and its evaluation. The strategy adopted in this research was informed by recursive philosophy and theoretical perspectives within IS that strived to expound this recursive relationship. It involved conducting two longitudinal case studies that are qualitative in nature. The first study involved telehealth deployment and its evaluation in the UK, while the second case study involved the deployment of electronic medical/health records in the US. Data was collected through focus group discussions, interviews and online discussion threads; and was analysed thematically. The results of this research indicate that there are nine issues that arise and affect the deployment and evaluation of IS innovation in healthcare; and these are design, efficiency and effectiveness, optimality and equity, legitimacy, acceptance, demand and efficacy, expertise, new interaction patterns, and trust. These issues are attributes of relationships between the IS innovation, context of healthcare and the user. The significance of these attributes varies during the deployment and evaluation process, and due to iterative nature of IS innovation. This research further indicates that all the attributes have either direct or indirect impact on work practices of the user.
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Sattar, Abdus. "Create a Medical information Extraction tool applied on Electronic Patient Record systems mainly for Retrospective Research." Thesis, KTH, Skolan för informations- och kommunikationsteknik (ICT), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-121527.
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This paper deals with medical data extraction from electronic patient record (EPR) system. Most of the medical data are stored in patient record systems, and data that are much valuable for medical research. If a researcher wants to extract medical information today, it has to be done manually because the data are stored in unstructured textual format in a system created by hospital staff. There is no way of extracting data in structure way. This paper is going to introduce an information extraction application for EPR system that allows the researcher to set up a study with inclusion and parameters for extraction for retrospective surveys in a webuser-interface environment. Inclusion is what the researcher would like to study (a defined category or criteria) and parameters specify the characteristics of inclusion the criteria. Result of this application provides an extracted clinical data that is used for retrospective surveys, downloadable to an MS-Excel file.
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Lee, Koon-hung. "Communicating patients' medical information by online electronic health record system physicians and dentists' perception /." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31971933.
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Törnvall, Eva. "Carrying out electronic nursing documentation : use and development in primary health care /." Linköping : Department of Social and Welfare Studies, Linköping University, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-11268.
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Williams, Faustine. "The role of electronic medical record in nation care delivery, development case study on Ghana /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2007. http://hdl.handle.net/10355/4919.
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Thesis (M.S.)--University of Missouri-Columbia, 2007.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. "May 2007" Includes bibliographical references.
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Shelh, Malaz. "Usability evaluation of electronic dental record systems in Sweden : A survey among dentists and dental hygienists." Thesis, Linnéuniversitetet, Institutionen för medicin och optometri (MEO), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-104224.
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Electronic Dental Records (EDR) are an important part of dental care in Sweden. The usability of these records can affect the workflow in dental care organizations. This study aims to measure the System usability scale (SUS) score of EDRs that are used in dental clinics in Sweden. The study will also investigate the relationship between the SUS score of EDRs and participants’ age, gender, interest in technology, number of patients per workday, professional experience, possible special training to use the EDR, and the period of the training. The study will also rank the most common usability problem in EDRs among the seven possible usability problems included in the questionnaire. The study will present how the participants describe experienced usability problems in the EDRs. The quantitative method constitutes the largest part of this study, while the open-ended questions were used to get a deeper knowledge about some of the usability problems. A digital questionnaire was used in this study to gather data from 115 dentists and 77 dental hygienists who work at various dental clinics around Sweden to get a statistical anchored description about the usability of various EDRs. SUS indicates a low usability level in the EDRs included in the study and a significant negative correlation between the frequency of using EDRs and usability. The males showed better experience with the usability of the EDRs compared to females. The highest-ranked usability problem was the need for users to spend a long time to document patient cases. The usability problems were summarized into three categories which are: an inefficient user interface, lack of semantic interoperability, and users relying on paper.Elektroniska journalsystem är en viktig del av tandvården i Sverige, då användbarheten av dessa system kan påverka arbetsflödet i tandvårdsorganisationer. Denna studie syftar till att mäta System usability scale (SUS) poäng för olika elektroniska journalsystem som används i olika tandkliniker i Sverige. Studien kommer också att undersöka sambandet mellan SUS-poäng för elektroniska journalsystem och deltagarnas ålder, kön, intresse av teknologi, antal patienter per arbetsdag, yrkeserfarenhet, möjlig specialutbildning för att använda elektroniska journalsystem och perioden för denna utbildning. Studien kommer också att rangordna det vanligaste användbarhetsproblemet i journalsystem bland de sju möjliga användbarhetsproblemen som ingår i frågeformuläret. Studien kommer att presentera hur deltagarna beskriver upplevda användbarhetsproblem i journalsystem. Den kvantitativa metoden utgör den största delen av denna studie, medan de öppna frågorna användes för att få en djupare kunskap om några av användbarhetsproblemen. Ett digitalt frågeformulär användes i denna studie för att samla in data från 115 tandläkare och 77 tandhygienister som arbetar vid olika tandkliniker runt om i Sverige för att få en statistisk förankrad beskrivning om användbarheten av olika elektroniska journalsystem. SUS indikerar en låg användbarhetsnivå i de systemen som ingår i studien. Vi upptäckte också en signifikant negativ korrelation mellan frekvensen av att använda systemen och användbarhetsnivån. Män visade en bättre upplevelse för användbarhet av systemen jämfört med kvinnor. Det högst rankade användbarhetsproblemet var användarnas behov av lång tid för att dokumentera patientfall. Vi sammanfattade hur deltagarna beskriver upplevda användbarhetsproblem i journalsystem under tre kategorier som är: ett ineffektivt användargränssnitt, brist på semantisk interoperabilitet och användare som skriver på en lapp.
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Warren, Richard Alton. "Exploring Strategies for Successful Implementation of Electronic Health Records." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4261.
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Adoption of electronic health records (EHR) systems in nonfederal acute care hospitals has increased, with adoption rates across the United States reaching as high as 94%. Of the 330 plus acute care hospital EHR implementations in Texas, only 31% have completed attestation to Stage 2 of the meaningful use (MU) criteria. The purpose of this multiple case study was to explore strategies that hospital chief information officers (CIOs) used for the successful implementation of EHR. The target population consists of 3 hospitals CIOs from a multi-county region in North Central Texas who successfully implemented EHRs meeting Stage 2 MU criteria. The conceptual framework, for this research, was the technology acceptance model theory. The data were collected through semistructured interviews, member checking, review of the literature on the topic, and publicly available documents on the respective hospital websites. Using methodological triangulation of the data, 4 themes emerged from data analysis: EHR implementation strategies, overcoming resistance to technology acceptance, strategic alignment, and patient wellbeing. Participants identified implementation teams and informatics teams as a primary strategy for obtaining user engagement, ownership, and establishing a culture of acceptance to the technological changes. The application of the findings may contribute to social change by identifying the strategies hospital CIOs used for successful implementation of EHRs. Successful EHR implementation might provide positive social change by improving the quality of patient care, patient safety, security of personal health information, lowering health care cost, and improvements in the overall health of the general population.
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Blackman-Lees, Shellon. "Towards a Conceptual Framework for Persistent Use: A Technical Plan to Achieve Semantic Interoperability within Electronic Health Record Systems." NSUWorks, 2017. http://nsuworks.nova.edu/gscis_etd/998.
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Semantic interoperability within the health care sector requires that patient data be fully available and shared without ambiguity across participating health facilities. The need for the current research was based on federal stipulations that required health facilities provide complete and optimal care to patients by allowing full access to their health records. The ongoing discussions to achieve interoperability within the health care industry continue to emphasize the need for healthcare facilities to successfully adopt and implement Electronic Health Record (EHR) systems. Reluctance by the healthcare industry to implement these EHRs for the purpose of achieving interoperability has led to the current research problem where it was determined that there is no existing single data standardization structure that can effectively share and interpret patient data within heterogeneous systems. The current research used the design science research methodology (DSRM) to design and develop a master data standardization and translation (MDST) model that allowed seamless exchange of healthcare data among multiple facilities. To achieve interoperability through a common data standardization structure, where multiple independent data models can coexist, the translation mechanism incorporated the use of the Resource Description Framework (RDF). Using RDF, a universal exchange language, allowed for multiple data models and vocabularies to be easily combined and interrelated within a single environment thereby reducing data definition ambiguity. Based on the results from the research, key functional capabilities to effectively map and translate health data were documented. The research solution addressed two primary issues that impact semantic interoperability – the need for a centralized standards repository and a framework that effectively maps and translates data between various EHRs and vocabularies. Thus, health professionals have a single interpretation of health data across multiple facilities which ensures the integrity and validity of patient care. The research contributed to the field of design science development through the advancements of the underlying theories, phases, and frameworks used in the design and development of data translation models. While the current research focused on the development of a single, common information model, further research opportunities and recommendations could include investigations into the implementation of these types of artifacts within a single environment at a multi-facility hospital entity.
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Adams, Sharon L. "Nurses Knowledge, Skills, and Attitude Toward Electronic Health Records (EHR)." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/875.
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Information technology (IT) has been rapidly integrated into the healthcare industry, including nursing, and has the ability to reduce errors, cut cost, and enhance patient care. However, approximately 45% of the current nurse workforce lacks adequate training in computer skills, which may hinder the adoption of health-related IT in the workplace. Characteristics of Rogers's diffusion of innovation (relative advantage, compatibility, complexity, trialability, and observability) guided this project. This project was conducted to address the problem of IT adoption on a local level and was designed to assess whether simulation training on a generic electronic health record (EHR) system would improve the knowledge, skill, and attitude of nurses with little or no experience with EHR. A convenience sample of nurses (n = 13) unfamiliar with EHR was obtained by posting flyers in long-term care or home health agencies. The nurses completed the P.A.T.C.H. assessment scale v. 3 (2011) before and after participating in the one-time simulation training on EHR. Scores on the P.A.T.C.H. were calculated according to the established scoring system and revealed a positive increase nurses' attitude and self-efficacy toward the EHR system. Posttest scores yielded an increase ranging from 0.5 to 5 points from pretest scores, with an average pretest score of 54.23 on a scale of 0-100. The results of this project are consistent with the literature and current research and illustrate the importance of addressing the need for interactive training. This project contributes to social change in practice by enhancing the awareness of EHR in nurses who are new users of IT and promoting the adoption of technology in healthcare.
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Drill, Valerie Gerene. "A Multisite Hospital's Transition to an Interoperable Electronic Health Records System." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3293.
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The health care industry is transforming into an industry that requires health information technology, yet many health care organizations are reluctant to implement new technology. The purpose of this case study was to explore strategies that led to a successful transition from an older electronic health record (EHR) system to a compliant EHR system at a multisite hospital system (MHS). The study included face-to-face and phone interviews with 12 managers who worked on the transition of an MHS's EHR system in the Pacific Northwest region of the United States. The technology acceptance model was used to frame the study. Audio recordings with these managers were transcribed and analyzed along with interview notes and publicly available documents to identify themes regarding strategies used by managers to successfully upgrade to a compliant EHR system at an MHS. Three major themes emerged: hybrid implementation strategy, training strategy, and social pressure strategy. Results may be used to facilitate the adoption of information technology systems in any industry. Results may directly benefit other MHSs by facilitating successful EHR system transitions. Implications for social change include improved care coordination, reductions in duplicated medical procedures, and more timely and relevant tests for patients through the full use of EHRs.
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Nicholas, Marcia M. "Successful Strategies for Implementing EMR Systems in Hospitals." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5386.
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Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter's 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles.
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Diana, Mark L. "Information Technology Outsourcing in U.S. Hospital Systems." VCU Scholars Compass, 2006. https://scholarscompass.vcu.edu/etd/1093.
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The purpose of this study was to determine the factors associated with outsourcing of information systems (IS), and if there is a difference in IS sourcing based on the strategic value of the outsourced functions. The theoretical framework is based upon a synthesis of strategic management theory (SMT) and transaction cost economics (TCE) as they apply to vertical integration in the health care sector; therefore, IS sourcing behavior was conceptualized as a case of vertical integration. The conceptual model proposed that sourcing behavior would be determined by asset specificity, uncertainty, the interaction of asset specificity and uncertainty, bargaining power, corporate strategy needs, and the strategic value of the IS functions outsourced.A cross sectional design was used, consisting of data from the American Hospital Association (AHA), the Area Resource File (ARF), the HIMSS Analytics database, and the Centers for Medicare and Medicaid Services (CMS) hospital cost reports for 2003. The final sample consisted of 1,365 health care delivery systems and 3,452 hospitals. Analysis was conducted using a two-stage negative binomial regression model (using instrumental variables) to correct for suspected endogeneity. Tests of joint restrictions using the group of variables derived from TCE and SMT, respectively, were done with the dependent variable divided between strategic and non-strategic IS functions (the division was done based on a model of Core IS Capabilities developed as a model for a high-performance IS function).The results supported the relationship between bargaining power and IS outsourcing. Results for asset specificity and corporate strategy needs were significant in the opposite direction than hypothesized. No other findings were significant. These results suggest that hospital system managers are likely not considering significant factors when making sourcing decisions, including the relative strategic value of the functions they are outsourcing. This study contributes to the limited body of knowledge surrounding IS sourcing behavior in the health care sector. Future research should examine the effect of cost on IS sourcing decisions, and consider the use of alternative theoretical frameworks, particularly Institutional Theory.