Dissertations / Theses: 'Electronic health record'

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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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Huang, Qian, and Qin Yin. "Study on Electronic Health Record and its Implementation." Thesis, Högskolan Kristianstad, Sektionen för hälsa och samhälle, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-9464.

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This degree project deals with electronic health record (EHR). The report is divided into two main sections; literature study on electronic health record and an EHR system implementation. In the literature study section, EHR background, development history and service condition are introduced. The paper focuses on the sharing of medical information in different users, data safety and privacy. The adjunctions of computer science, technologies are used to solve the medical informatics’ problems. In the implementation section, based on the study of the current EHR systems, the design and implement of a shared EHR system are presented, which can be accessed by different doctors and patients. Access control function and cryptography protections are included in this system. The system test and evaluation are also given.

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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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Najaftorkaman, Mohammadreza. "Facilitators and Barriers to User Adoption of Electronic Health Record Systems." Thesis, Griffith University, 2016. http://hdl.handle.net/10072/368008.

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Information Technology (IT) applications have brought massive changes in healthcare and health providers have shifted from paper-based systems to computerized ones. The electronic medical record (EMR) and personal health record (PHR) are good examples of the application of IT in healthcare settings. Despite the enormous benefits of the available applications in healthcare, the adoption of EMR in primary care has been identified at 38.4 percent in the U.S., in Denmark, almost 62 percent of doctors use EMR, while only 55 percent of Australian physicians apply EMR systems (Sicotte et al. 2016; Venkatesh et al. 2011). Furthermore, with regard to the PHR system, the Australian government’s development of a national PHR system (personally controlled electronic health record (PCEHR) system) in 2010 was a part of their national e-health strategy to overcome common challenges such as medication errors, fragmented sources of health information, repetition of tests, an increase in chronic illness, workforce resource constraints, and individuals’ changing expectations of technology. The Australian government expected that 500,000 users would register at the first release of the national PHR system; however, only 400,000 users have signed up to this system and of those, many registered but their records remain empty.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of information and Communication Technology
Science, Environment, Engineering and Technology
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Simpson, Johnnie Lee Jr. "Examining differences in electronic health record adoption and motivations." Thesis, Capella University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3637298.

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My dissertation research aims to provide greater knowledge about the healthcare industry and federal budgets, within the education and infrastructure. The view point of the financials spent in the United States on healthcare is supported by the economic reports and facts dealing with the studies that the current cost is unstainable. It is also likely that rates of EHR adoption increased after the healthcare legislation associated with the administration of President Barack Obama.

Together, these two pieces of legislation represent a challenge for healthcare providers in the United States, as such providers will have not only to adopt EHR if they have not done so already, but they must also prepare for a torrent of new patients who typically have not had medical care—especially those eligible for Medicaid benefits.

One problem raised by the new healthcare legislation, according to Frenkel (2010), is that it unknown how the adoption of EHR will affect smaller healthcare providers financially and in terms of service, especially those that accept Medicaid reimbursement. Most EHR literature addresses circumstances before the passage of the ARRA of 2009 and the PPACA. While there are reliable figures for nationwide EHR adoption, Frenkel (2010) argued that some key questions remain unanswered:

1. Are Medicaid providers more advanced in EHR adoption than non-Medicaid providers?

2. What are the main obstacles to, and incentives for, adopting EHR in the new era of American healthcare?

3. Are obstacles and incentives different from those in the past before the new healthcare legislation, or are they similar to previous obstacles and incentives?

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Gregory, Judith. "Sorcerer's apprentice : creating the electronic health record, re-inventing medical records and patient care /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2000. http://wwwlib.umi.com/cr/ucsd/fullcit?p9992380.

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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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Barry, Sacha (Sacha M. ). "Critical factors for successful electronic health record (EHR) implementation." Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104546.

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Thesis: S.M. in Management Studies, Massachusetts Institute of Technology, Sloan School of Management, 2016.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 68-75).
Since the 1970s, the healthcare industry has been moving from paper-based documents towards computer information systems in an effort to increase timely access to quality information, with the ultimate objective of wide dissemination and adoption of Electronic Health Records (EHRs). EHRs are electronic collections of patient health information that are recorded by physicians, nurses and patients themselves, before being approved by physicians and shared across diverse settings. EHR implementation can improve care quality and efficiency and physician productivity and reduce healthcare costs. However, implementation often proves to be difficult. This paper reviews several common issues associated with EHR adoption including negative impacts on quality of care, physicians' productivity, patients' safety and organizations' financials from high maintenance and implementation costs. It then summarizes critical success factors found in the literature. It eventually examines two cases studies of Enterprise Resource Planning (ERP) implementation in the automotive and food and beverage industries and leverages ERP implementation best practices to develop a practical framework for successful HER adoption. Hopefully, it will be useful for future EHR adoption projects in the U.S. and other regions of the world.
by Sacha Barry.
S.M. in Management Studies

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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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Wissel, Benjamin D. "Generalizability of Electronic Health Record-Based Machine Learning Models." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1627659161796896.

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Velte, Linda Maria. "Electronic health record repository based on the openEHR standard." Master's thesis, Universidade de Aveiro, 2011. http://hdl.handle.net/10773/7479.

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Mestrado em Engenharia de Computadores e Telemática
An Electronic Health Record (EHR) aggregates all relevant medical information regarding a single patient, allowing a patient centric storage approach. This way the complete medical history of a patient is stored together in one record, making it possible to save time and work by allowing the sharing of information between health care institutions. To make this sharing possible there has to be agreed on the format in which the information is saved. There are many standards to de ne the way health information is stored, exchanged and retrieved. One of this standards is the Open Electronic Health Record (OpenEHR). The goal of this thesis is to create a repository which allows to store and manage patient records which follow the OpenEHR standard. The result of the implementation consists in three software parts, being them a Extensible Markup Language (XML) repository to store health information, a set of services allowing to manage and query the information stored and a web interface to demonstrate the implemented functionalities.
Um registo electrónico de saúde agrega toda a informação médica relevante de um paciente, permitindo uma filosofia de armazenamento orientada ao mesmo. Desta forma todo o historial médico do paciente encontra-se armazenado num único registo, permitindo a optimização de custos e tempo gasto nas diferentes tarefas, através de partilha de informação entre diferentes instituições médicas. Para possibilitar esta partilha é necessário definir um formato comum em que a informação é armazenada. Para tal foram definidas diversas normas que ditam as regras de armazenamento, troca e recuperação de informação médica. Uma destas normas é o Open Electronic Health Record (OpenEHR). O objectivo desta dissertação e criar um reposit orio que permite o armazenamento de registos médicos que sigam a norma OpenEHR. A implementação dá origem a três componentes de software, sendo eles uma base de dados Extensible Markup Language (XML) para armazenamento de registos médicos, um conjunto de serviços para gestão e pesquisa da informação armazenada e uma interface web para demonstração das funcionalidades implementadas.

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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 Telemática
Low-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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Foster, Christopher A. "Electronic Health Record Implementation Strategies for Decreasing Healthcare Costs." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6426.

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Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment.

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Baron, Karen. "Incorporating Personal Health Records into the Disease Management of Rural Heart Failure Patients." NSUWorks, 2012. http://nsuworks.nova.edu/gscis_etd/85.

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Personal Health Records (PHRs) allow patients to access and in some cases manage their own health records. Their potential benefits include access to health information, enhanced asynchronous communication between patients and clinicians, and convenience of online appointment scheduling and prescription refills. Potential barriers to PHR use include lack of computer and internet access, poor computer or health literacy, security concerns, and provider disengagement. PHRs may help those living in rural areas and those with chronic conditions such as heart failure, monitor and manage their disease, communicate with their health care team and adhere to clinical recommendations. To provide some much needed actual research, a descriptive mixed methods study of the usability, usefulness, and disease management potential of PHRs for rural heart failure patients was conducted. Fifteen participants were enrolled. Usability issues fell into three categories: screen layout; applying consistent, standard formatting; and providing concise, clear instructions. Participants used PHR features that were more convenient than other methods or that had some additional benefit to them. There was no difference between rural and urban participants. A heart failure nurse promoted recording daily heart failure symptoms in the PHR. Most participants did so at least once, but many found it cumbersome. Reasons for recording included the comfort of having clinical staff monitor the data. Participants who were stable did not find recording as useful as did those who were newly diagnosed or unstable. Participants used asynchronous communication to send messages to the heart failure nurse that they would not otherwise have communicated. The study expands the knowledge of PHR use by addressing useful functionality and disease management tools among rural patients with heart failure. The patients were able to complete tasks they found useful. The increased communication and disease management tools were useful to some.

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Moner, Cano David. "Archetype development and governance methodologies for the electronic health record." Doctoral thesis, Universitat Politècnica de València, 2021. http://hdl.handle.net/10251/164916.

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[ES] La interoperabilidad semántica de la información sanitaria es un requisito imprescindible para la sostenibilidad de la atención sanitaria, y es fundamental para afrontar los nuevos retos sanitarios de un mundo globalizado. Esta tesis aporta nuevas metodologías para abordar algunos de los aspectos fundamentales de la interoperabilidad semántica, específicamente aquellos relacionados con la definición y gobernanza de modelos de información clínica expresados en forma de arquetipo. Las aportaciones de la tesis son: - Estudio de las metodologías de modelado existentes de componentes de interoperabilidad semántica que influirán en la definición de una metodología de modelado de arquetipos. - Análisis comparativo de los sistemas e iniciativas existentes para la gobernanza de modelos de información clínica. - Una propuesta de Metodología de Modelado de Arquetipos unificada que formalice las fases de desarrollo del arquetipo, los participantes requeridos y las buenas prácticas a seguir. - Identificación y definición de principios y características de gobernanza de arquetipos. - Diseño y desarrollo de herramientas que brinden soporte al modelado y la gobernanza de arquetipos. Las aportaciones de esta tesis se han puesto en práctica en múltiples proyectos y experiencias de desarrollo. Estas experiencias varían desde un proyecto local dentro de una sola organización que requirió la reutilización de datos clínicos basados en principios de interoperabilidad semántica, hasta el desarrollo de proyectos de historia clínica electrónica de alcance nacional.
[CA] La interoperabilitat semàntica de la informació sanitària és un requisit imprescindible per a la sostenibilitat de l'atenció sanitària, i és fonamental per a afrontar els nous reptes sanitaris d'un món globalitzat. Aquesta tesi aporta noves metodologies per a abordar alguns dels aspectes fonamentals de la interoperabilitat semàntica, específicament aquells relacionats amb la definició i govern de models d'informació clínica expressats en forma d'arquetip. Les aportacions de la tesi són: - Estudi de les metodologies de modelatge existents de components d'interoperabilitat semàntica que influiran en la definició d'una metodologia de modelatge d'arquetips. - Anàlisi comparativa dels sistemes i iniciatives existents per al govern de models d'informació clínica. - Una proposta de Metodologia de Modelatge d'Arquetips unificada que formalitza les fases de desenvolupament de l'arquetip, els participants requerits i les bones pràctiques a seguir. - Identificació i definició de principis i característiques de govern d'arquetips. - Disseny i desenvolupament d'eines que brinden suport al modelatge i al govern d'arquetips. Les aportacions d'aquesta tesi s'han posat en pràctica en múltiples projectes i experiències de desenvolupament. Aquestes experiències varien des d'un projecte local dins d'una sola organització que va requerir la reutilització de dades clíniques basades en principis d'interoperabilitat semàntica, fins al desenvolupament de projectes d'història clínica electrònica d'abast nacional.
[EN] Semantic interoperability of health information is an essential requirement for the sustainability of healthcare, and it is essential to face the new health challenges of a globalized world. This thesis provides new methodologies to tackle some of the fundamental aspects of semantic interoperability, specifically those aspects related to the definition and governance of clinical information models expressed in the form of archetypes. The contributions of the thesis are: - Study of existing modeling methodologies of semantic interoperability components that will influence in the definition of an archetype modeling methodology. - Comparative analysis of existing clinical information model governance systems and initiatives. - A proposal of a unified Archetype Modeling Methodology that formalizes the phases of archetype development, the required participants, and the good practices to be followed. - Identification and definition of archetype governance principles and characteristics. - Design and development of tools that provide support to archetype modeling and governance. The contributions of this thesis have been put into practice in multiple projects and development experiences. These experiences vary from a local project inside a single organization that required a reuse on clinical data based on semantic interoperability principles, to the development of national electronic health record projects.
This thesis was partially funded by the Ministerio de Economía y Competitividad, ayudas para contratos para la formación de doctores en empresas “Doctorados Industriales”, grant DI-14-06564 and by the Agencia Valenciana de la Innovación, ayudas del Programa de Promoción del Talento – Doctorados empresariales (INNODOCTO), grant INNTA3/2020/12.
Moner Cano, D. (2021). Archetype development and governance methodologies for the electronic health record [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/164916
TESIS

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Mejia, Susan. "Strategies Rural Hospital Leaders Use to Implement Electronic Health Record." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5225.

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The Centers for Medicare and Medicaid Services issued over 144,000 payments totaling $7.1 billion to medical facilities that have adopted and successfully demonstrated meaningful use of certified electronic health record (EHR). Hospital organizations can increase cost savings by using the electronic components of EHRs to improve medical coding and reduce medical errors and transcription costs. Despite the incentives, some rural health care facilities are failing to progress. The purpose of this multiple case study was to explore the strategies rural hospital leaders used to implement an EHR. The target population consisted of rural hospital leaders who were involved in the successful implementation of an EHR in South Texas. The conceptual framework chosen for this study was the sociotechnical systems theory. Data were collected through telephone interviews using open-ended semistructured interviews with 5 participants from 4 rural hospitals who were involved in the EHR implementation. Data analysis occurred using Yin's 5-step process which includes compiling, disassembling, reassembling, interpreting, and concluding. Data analysis included collecting information from government websites, company documents, and open-ended information to develop recurring themes. Several themes emerged including ongoing training, provider buy-in, constant communication, use of super users, and workflow maintenance. The findings could influence social change by making the delivery of health care more efficient and improving quality, safety, and access to health care services for patients.

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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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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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19

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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20

Fernández, Alexis Martínez. "Authorization schema for electronic health-care records : For Uganda." Thesis, KTH, Kommunikationssystem, CoS, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-101165.

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This master’s thesis project began at the Karolinska University Hospital. This thesis discusses how to design an authorization schema focused on ensuring each patient’s data privacy within a hospital information system. It begins with an overview of the current problem, followed by a review of related work. The overall project’s goal is to create and evaluate an authorization schema that can ensure each patient’s data confidentiality. Authorization has currently become a very important aspect in information systems, to the point of being a necessity when implementing a complete system for managing access control in certain complex environments. This requirement lead to the approach that this master thesis takes for effectively reasoning about authorization requests in situations where a great number of parameters could affect the access control assessment. This study is part of the ICT4MPOWER project developed in Sweden by both public and private organizations with the objective of improving health-care aid in Uganda through the use of information and communication technologies. More concretely, this work defines an authorization schema that can cope with the increasing needs of sophisticated access control methods where a complex environment exists and policies require certain flexibility.
Detta examensarbete projektet startade vid Karolinska Universitetssjukhuset. Denna avhandling diskuterar hur man designar ett tillstånd schema fokuserat på att säkerställa varje patients dataskydd inom ett sjukhus informationssystem. Det börjar med en översikt över det aktuella problemet, följt av en genomgång av arbete. Projektets övergripande mål är att skapa och utvärdera ett tillstånd schema som kan garantera varje patient data sekretess. Bemyndigande har för närvarande blivit en mycket viktig aspekt i informationssystem, till den grad att vara nödvändigt att genomföra komplett system för hantering av åtkomstkontroll i vissa komplexa miljöer. Detta är i själva verket den strategi som detta examensarbete tar för att effektivt resonemang om en ansökan om godkännande i situationer där ett stort antal parametrar kan påverka i åtkomstkontroll bedömningen. Denna studie är en del av ICT4MPOWER projektet utvecklades i Sverige av både offentliga och privata organisationer i syfte att förbättra stödet sjukvård i Uganda med användning av informations-och kommunikationsteknik.<p> Mer konkret definierar detta arbete ett tillstånd schema som kan hantera de ökande behoven av sofistikerade metoder för åtkomstkontroll där en komplex miljö finns och politik kräver en viss flexibilitet.

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21

Dewart, Courtney McAlear. "Evaluating Risk Factors for Antimicrobial Resistance Using Electronic Health Record Data." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1555234514305512.

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22

Eyoh, Unyime. "Polypharmacy, the Electronic Medical Record, and Adverse Drug Events." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2535.

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Polypharmacy, a concurrent chronic use of multiple prescribed and over-the-counter medications by the same individual, is one of the clinical problems facing primary care providers. Polypharmacy creates the potential for adverse drug-related events, especially in the elderly. The advent of electronic medical records (EMR) may help identify and respond to these potential adverse events. The purpose of this project was to investigate the relationship between the total number of medication taken by elderly, 65 years and older, and the severity of drug-drug and drug-disease interactions triggered by the EMR system. The study used a retrospective chart review of the EMRs. Three independent variables (age, gender, and number of medications) and 4 dependent variables (major drug-drug, moderate drug-drug, major drug-drug, and moderate drug-drug interactions) were analyzed among a sample of 247 individuals, ranging in age from 65 to 98 years. The total number of medications used among this sample ranged from 2 to 27 medications, with 177 (71.7%) patients using 2 to 9 medications, and 70 (28.3%) using 10 or more medications. Correlational analysis showed a positive relationship between number of medication and major drug-drug, moderate drug-drug, major drug-disease, and moderate drug-disease interactions (r = 0.240, p = 0.0001; r = .596, p = 0.0001; r = 464, p =0.0001; r = 669, p = 0.0001, respectively). However, there was no significant relationship between age and major and moderate drug-drug and drug disease interactions. The results of this study contribute to positive social change by increasing primary care providers' understanding of the EMR as a tool to improve the identification and management of patients with polypharmacy.

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23

Poon, Wai-yin, and 潘慧賢. "Review of the implementation of electronic health record in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B50257456.

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eHR is one of the main development area in healthcare sector to ensure a high quality and effective healthcare service in Hong Kong is provided. However, the present development of eHR in Hong Kong is mainly focused on public sectors healthcare providers – the hospitals and clinics under HA and DH. Most of the private hospitals and clinics are still using paper based health records. Although some of them may have implemented their own eHR systems, there is no interconnection among other healthcare providers. In this dissertation, the eHR system development in Hong Kong for both public and private sectors will be reviewed, to figure out the development of eHR and various clinical management systems, as well as the problems facing by the healthcare workers and patients. Also, HKSAR government shows supportive to the eHR development both in the governance and financial aspects. To facilitate the coordination of developing her sharing system among different healthcare providers, an eHR Office has been setup under Food and Health Bureau for this purpose. The eHR office will monitor the progress of the eHR development process. As HA has a well-developed world-known Clinical Management System (CMS), which handles patient records in electronic forms in public hospitals daily. HA acts as one major advisor in her implementation for HKSAR. Data privacy and data security issues are the major concerns of healthcare workers and patients. The Personal Data Protection Ordinance (PDPO) provides protection on the data privacy in legal aspect. However, no legislation on data privacy has been specified for eHR currently. Meanwhile, various physical security protections have been adopted in the implementation of eHR in technology side, which provided a certain level of data security to the system. Chinese Medicine has been developed rapidly recently, it is expected the Chinese Medicine would become one of the core service area in healthcare sector in Hong Kong, sharing the healthcare service with the Western Medicine. However, there is no integration between Chinese Medicine and Western Medicine in current her sharing system development. eHR development involves huge investment, to evaluate the feasibility of developing the eHR system, a scientific tool is recommended, a Cost and Benefit Analysis is hence conducted for the eHR in Hong Kong, to compare the effectiveness of eHR with the traditional paper-based health records in the healthcare setting. As recommended from the CBA, the eHR system will be developed with the consideration on the system flexibility and the adaptability from all the healthcare providers. On the other hand, the implementation of the her system will be a long and complex process and will require the contribution and participation from all parties.
published_or_final_version
Politics and Public Administration
Master
Master of Public Administration

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24

Aldajani, Mouhamad. "Electronic patient record security policy in Saudi Arabia National Health Service." Thesis, De Montfort University, 2012. http://hdl.handle.net/2086/6016.

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Saudi Arabia is in the process of implementing Electronic Patient Records (EPR) throughout its National Health services. One of the key challenges during the adoption process is the security of EPR. This thesis investigates the current state of EPR security in Saudi Arabia’s National Health Services (SA NHS) both from a policy perspective and with regard to its implementation in SA NHS’s information systems. To facilitate the analysis of EPR security, an EPR model has been developed that captures the information that is stored as part of the electronic record system in conjunction with stated security requirements. This model is used in the analysis of policy consistency and to validate operational reality against stated policies at various levels within the SA NHS. The model is based on a comprehensive literature survey and structured interviews which established the current state of practice with respect to EPRs in a representative Saudi Arabian hospital. The key contribution of this research is the development and evaluation of a structured and model-based analysis approach to EPR security at the early adoption stage in SA, based on types of information present in EPRs and the needs of the users of EPRs. The key findings show that the SA EPR adoption process is currently proceeding without serious consideration for security policy to protect EPR and a lack of awareness amongst hospital staff.

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25

Fareed, Naleef. "Hospital Electronic Health Record Adoption and its Influence on Postoperative Sepsis." VCU Scholars Compass, 2013. https://scholarscompass.vcu.edu/etd/3003.

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Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient safety performance in relation to one hospital acquired condition: postoperative sepsis – a condition that complicates hospitalizations, increases lengths of stay, and leads to higher mortality rates. Administrative data from several sources were utilized in order to obtain comprehensive information about the patient, organizational, and market characteristics of hospitals, their EHR adoption patterns, and the occurrence of postoperative sepsis among their patients. The study sample consisted of 404 general, short-term, acute care, non-federal, and urban hospitals based in six states, which provided longitudinal data from 2005 to 2009. Hospital EHR and the EHR’s sophistication level were measured by the presence of eight clinical applications. Econometric techniques were used to test six hypotheses that were derived from macro-organizational theories and frameworks. After controlling for potential confounders, the study’s key findings suggested that hospitals had a significant increase in the probability of having EHR as the percent of other hospitals having the most sophisticated EHR (i.e., EHRS3) in the market increased. Conversely, hospitals had a significant decrease in the probability of having EHR when the percent of Medicaid patients increased within a hospital or when the hospital belonged to centralized or moderately centralized systems. Also, the study findings suggested that EHR was associated with a higher rate of postoperative sepsis. Specifically, the intermediate EHR sophistication level (i.e., EHRS2) and the most sophisticated EHR level (i.e., EHRS3) were associated with a significantly higher rate of postoperative sepsis when compared to hospitals that did not have such EHR sophistication. The study results, however, did not support the hypotheses that higher degrees of fit between hospitals’ EHR sophistication level and specific structural dimensions were associated with greater reductions in postoperative sepsis outcomes vis-à-vis hospitals that did not have these types of fit.

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26

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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27

Sesay, Nanah Sheriff. "Development of an Electronic Health Record Educational Project for Staff Nurses." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1214.

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Abstract The use for electronic health records (EHRs) by 2015 is being mandated through incentive payments for health care providers. Evidence-based literature has shown that almost half of the hospitals in the Unites States have not adopted EHRs, and many nurses have not been educated to effectively use them. In order to enhance and sustain EHR adoption by hospitals, nurses need to be educated on EHRs' usability. The purpose of this project was to develop an evidence-based EHR educational project for nurses on how to enter nursing assessments, document patients' medical data, and communicate effectively with patients and health care providers. The development of this educational project was guided by Ajzen's theory of planned behavior. An advisory committee of 5 members determined the effectiveness and usefulness of the project. The advisory committee was comprised of the director of nursing, the director of information technology, a nurse manager, a nursing informatics specialist, and a staff nurse. Findings from the advisory committee indicated the project was in alignment with the objectives for meaningful use of EHR adoption by hospitals, conformed to the quality standards established by the agency for which this project was developed, and provided educational materials that were helpful in enhancing staff nurses understanding of EHR usability. In addition, feedback from the nurses who reviewed the educational project indicated that they were concerned about frequent upgrades and customization that were being made in Epic and the project was useful in enhancing staff nurses understanding of Epic usability. This project has the potential of increasing staff nurses' efficiency in using the Epic EHR system.

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28

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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Jing, Xia. "Constructing a bio-health knowledge base for access via a standardised electronic health record prototype." Thesis, University of Salford, 2009. http://usir.salford.ac.uk/26738/.

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Aim and Objectives: To explore the feasibility of accessing biological information and associated health information through a standards-based electronic health record. The objectives include constructing: a condition specific knowledge base prototype; an EHR system prototype based on a standard record architecture; and an interface that connects the two. Method: An ontology was constructed to organise biological and health information in a formal and structured way. Cystic fibrosis was selected as an exemplar condition and the Continuity of Care Record was selected for an EHR prototype application. The sequence variations information and health information in the knowledge base are presented through the EHR prototype's interface and the results are evaluated. Results: A substantive knowledge base prototype of cystic fibrosis was constructed. The content includes: the most common genetic mutations related to cystic fibrosis; time-oriented descriptions of cystic fibrosis; Cochrane conclusions; and gene therapy for cystic fibrosis. The content is organised on both time and problem oriented axes. It was found to be possible to present bio-health information that was case-specific through the EHR prototype interface. Conclusion: Sequence variations information and associated health information can be made accessible through a standards-based electronic health record prototype. Complex knowledge can be accessed, to some extent automatically, thereby providing a starting point for integrating formal and structured biological information within health record systems which can be deployed in clinical settings.

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30

Wong, Sze-nga, and 王絲雅. "The impact of electronic health record on diabetes management : a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193850.

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Objectives: To investigate the impact of electronic health record (EHR) on diabetes management through examination of the effectiveness of implementation of EHR and to improve the quality of care and the cost-effectiveness on the use of EHR. Methods: Three databases, PubMed, Ovid Medline and Google Scholar, were searched with specific combination keywords including electronic medical record and electronic health record, and diabetes. Quality appraisal and extraction of data were conducted on literature that met with the inclusion criteria. Results: 10 literature studies, a total of 204,251 participants with diabetes, were included in this study. All subjects, with similar demographic and clinical characteristics, were from clinic and primary care setting with the use of EHR. Different outcome measures were compared and to evaluate the effectiveness of EHR on quality of care and cost-effectiveness. Discussion: The impact of EHR on effectiveness of diabetes management, potential factors of barrier for adoption and the limitation for implementation of EHR were discussed. These suggested that further research is needed to have stronger evidence to widespread the use of EHR in Hong Kong as a future direction on public health issue. Conclusion: In this systematic review, EHR showed potential benefit in improving the quality of care and reduce the health care expenditure for long term running. Patient safety and efficiency are yet to be covered in the studies. Further research is needed on the acceptability and applicability of the use of EHR in Hong Kong.
published_or_final_version
Public Health
Master
Master of Public Health

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31

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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32

Cunningham, Scott. "My diabetes my way : an electronic personal health record for NHS Scotland." Thesis, University of Dundee, 2014. https://discovery.dundee.ac.uk/en/studentTheses/24b55130-8e8a-4316-8681-b9f4d8513631.

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Background: Diabetes prevalence in Scotland is increasing at ~4.6% annually; 247,278 (4.7%) in 2011. My Diabetes My Way (MDMW) is the NHS Scotland information portal, containing validated educational materials for people with diabetes and their carers. Internet-based interventions have potential to enhance self-management and shift power towards the patient, with electronic personal health records (PHRs) identified as an ideal method of delivery. In December 2010, a new service was launched in MDMW, allowing patients across Scotland access to their shared electronic record. The following thesis aims to identify and quantify the benefits of a diabetes-focused electronic personal health record within NHS Scotland. Methods: A diabetes-focused, population-based PHR was developed based on data sourced from primary, secondary and tertiary care via the national diabetes system, Scottish Care Information - Diabetes Collaboration (SCI-DC). The system includes key diagnostic information; demography; laboratory tests; lifestyle factors, foot and eye screening results; prescribed medication and clinical correspondence. Changes are tracked by patients over time using history graphs and tables, data items link to detailed descriptions explaining why they are collected, what they are used for and what normal values are, while tailored information links refer individuals to facts related to their condition. A series of quasi-experimental studies have been designed to assess the intervention using subjectivist, mixed-methods approaches incorporating multivariate analysis and grounded theory. These studies assess patient expectations and experiences of records access, system usage and uptake and provide preliminary analysis on the impact on clinical process outcomes. Survey questionnaires were used to capture qualitative data, while quantitative data were obtained from system audit trails and from the analysis of clinical process outcomes before and after the intervention. Results: By the end of the second year, 2601 individuals registered to access their data (61% male; 30.4% with type 1 diabetes); 1297 completed the enrolment process and 625 accessed the system (most logins=346; total logins=5158; average=8.3/patient; median=3). Audit trails show 59599 page views (95/patient), laboratory test results proving the most popular (11818 accesses;19/patient). The most utilised history graph was HbA1c (2866 accesses;4.6/patient). Users are younger, more recently diagnosed and have a heavy bias towards type 1 diabetes when compared to the background population. They are also likely to be a more highly motivated ‘early adopting’ cohort. Further analysis was performed to compare pre- and post-intervention clinical outcomes after the system had been active for nearly two and a half years. Results of statistical significance were not forthcoming due to limited data availability, however there are grounds for encouragement. Creatinine tests in particular improved following 1 year of use, with type 1 females in particular faring better than those in patient other groups. For other clinical tests such as HbA1c, triglycerides, weight and body mass index improvements were shown in mean and/or median values.96% of users believe the system is usable. Users also stated that it useful to monitor diabetes control (93%), improve knowledge (89%) and enhance motivation (89%). Findings show that newly diagnosed patients may be more likely to learn more about their new condition, leading to more productive consultations with the clinical team (98%). In the pre-project analysis, 26% of registrants expressed concerns about the security of personal information online, although those who actually went on to use it reported 100% satisfaction that their data were safe. Engagement remains high. In the final month of year two, 44.6% of users logged in to the system. 55.3% of users had logged in within the previous 3 months, 78.9% within the previous 6 months and 91.4% within the previous year. Some legacy PHRs have failed due to lack of uptake and deficiencies in usability, so as new systems progress, it is essential not to repeat the mistakes of the past. Feedback: "It is great to be able to view all of my results so that I can be more in charge of my diabetes".Conclusion: The MDMW PHR is now a useful additional component for the self-management of diabetes in Scotland. Although there are other patient access systems available internationally, this system is unique in offering access to an entire national population, providing access to information collected from all diabetes-related sources. Despite its development for the NHS Scotland environment, it has the potential to connect to any electronic medical record. This local and domain-specific knowledge has much wider applicability as outlined in the recommendations detailed, particularly around health service and voluntary sector ownership, patient involvement, administrative processes, research activities and communication. The current project will reach 5000 patients by the end of 2013.

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33

Larsen, Ethan. "Macroergonomics to Understand Factors Impacting Patient Care During Electronic Health Record Downtime." Diss., Virginia Tech, 2018. http://hdl.handle.net/10919/85041.

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Through significant federal investment and incentives, Electronic Health Records have become ubiquitous in modern hospitals. Over the past decade, these computer support systems have provided healthcare operations with new safety nets, and efficiency increases, but also introduce new problems when they suddenly go offline. These downtime events are chaotic and dangerous for patients. With the safety systems clinicians have become accustomed to offline, patients are at risk from errors and delays. This work applies the Macroergonomic methodology to facilitate an exploratory study into the issues related to patient care during downtime events. This work uses data from existing sources within the hospital, such as the electronic health record itself. Data collection mechanisms included interviews, downtime paper reviews, and workplace observations. The triangulation of data collection mechanisms facilitated a thorough exploration of the issues of downtime. The Macroergonomic Analysis and Design (MEAD) methodology was used to guide the analysis of the data, and identify variances and shifts in responsibility due to downtime. The analysis of the data supports and informs developing potential intervention strategies to enable hospitals to better cope with downtime events. Within MEAD, the assembled data is used to inform the creation of a simulation model which was used to test the efficacy of the intervention strategies. The results of the simulation testing are used to determine the specific parameters of the intervention suggestions as they relate to the target hospitals. The primary contributions of this work are an exploratory study of electronic health record downtime and impacts to patient safety, and an adaptation of the Macroergonomic Analysis and Design methodology, employing multiple data collection methods and a high-fidelity simulation model. The methodology is intended to guide future research into the downtime issue, and the direct findings can inform the creation of better downtime contingency strategies for the target hospitals, and possibly to offer some generalizability for all hospitals.
Ph. D.

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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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Morton, Mary Elizabeth Wiedenbeck Susan McCain Katherine Wootton. "Use and acceptance of an electronic health record : factors affecting physician attitudes /." Philadelphia, Pa. : Drexel University, 2008. http://hdl.handle.net/1860/2905.

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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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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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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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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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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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Glenn, Annalia. "Do electronic health record components improve the quality of health care in a primary care setting?" Connect to Electronic Thesis (CONTENTdm), 2010. http://worldcat.org/oclc/643296012/viewonline.

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Gartrell, Kyungsook. "Factors Associated with Electronic Personal Health Record Use among Registered Nurses for Their Own Health Management." Thesis, University of Maryland, Baltimore, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3636110.

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Background: Electronic personal health records (ePHRs) are consumer-centric tools that enable consumers to securely access, manage and share their health information with health care providers. Although the potential for ePHRs to improve healthcare is significant, there is no available evidence on health care professionals' use of ePHRs for their own health management. Nurses have a tremendous opportunity to assist and educate patients in ePHRs. Research has shown that ePHR adoption among patients were influenced by perceived usefulness and ease of use using the technology acceptance model (TAM). This study expanded the TAM adding perceived data privacy security protections and health promoting role models for the ePHR acceptance model.

Purpose: This study examined (1) characteristics associated with ePHR use by nurses: health, technology experience, and attitudes about privacy of electronic health information, (2) psychometric properties of the measures in the research model, (3) association of ePHR acceptance constructs: perceived usefulness, ease of use, data privacy and security protections, and health promoting role model with ePHR use, and (4) moderating effects of nurses characteristics: age, chronic illness and/or medication use, providers use of electronic personal health record (EHR) on the relationships between ePHR acceptance constructs and ePHR use.

Methods: Registered nurses working in hospitals and members of the nursing informatics community (NIC) completed an anonymous online survey in the Fall of 2013 (n=847). Differences between groups were examined using t-tests and χ² tests. The associations between nurses' characteristics and ePHR use were examined via multiple logistic regression models that also held constant possible confounding covariates and interaction terms.

Results: Less than half (41%) of the hospital nurses were ePHR users. The odds of ePHR use was significantly greater among those with chronic medical conditions/medication use (OR=1.64, 95% CI=1.06-2.53) and those whose health care providers used EHRs (OR=3.62, 95% CI=2.45-5.36) controlling for age, marital status, current positions and specialty area. ePHR use was more common among NIC nurses (72%). The odds of ePHR use was also increased among NIC nurses with providers that used EHRs (OR=5.99, 95% CI=1.40-25.61), but users were 70% less concerned about privacy of health information online than nonusers (OR=0.32, 95% CI=0.14-0.70) controlling for ethnicity, race and practice regions. The majority of both ePHR users and nonusers would grant access to their primary care providers. However, fewer ePHR users in both nursing groups granted permission to designated family members or friends, other care providers who care for them, or pharmacists to view ePHRs than nonusers who answered hypothetically. Sufficient reliability for usefulness, ease of use, and privacy and security protections, and health promoting role model scales were found (all Cronbach alphas>0.70). Three constructs contributed significantly to ePHR use after adjusting nursing group, age, chronic illness and medication use, and health care providers use of EHR (usefulness, OR=0.87, 95% CI=0.85-0.89; data privacy and security protection, OR=1.04, 95% CI=1.01-1.07; and health promoting role model, OR=1.07, 95% CI=1.04-1.11). Significant interactions existed between perceived data privacy and security protections and providers EHR use, and between perceived health promoting role model and age on ePHR use (p<0.05).

Conclusion: The study findings suggest practical insights for nurses. With the experience of using ePHRs, nurses can leverage use of ePHRs for patient education on chronic illness and medication management. Nurses in NIC can also play an important role in practical ePHR design to enhance functionality and security in ePHR with their specialties in nursing informatics.

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Heath, Michele Lynn. "THE IMPACT OF INDIVIDUAL LEARNING ON ELECTRONIC HEALTH RECORD ROUTINIZATION: AN EMPIRICAL STUDY." Cleveland State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=csu1528913179444217.

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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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Johnson, Robyn. "Predicting clinicians’ intentions towards the electronic health record (EHR) : an extended UTAUT model." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/75255.

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The Electronic Health Record (EHR) has the potential to promote understanding or awareness of healthcare knowledge among patients and healthcare providers to facilitate collaboration between various key stakeholders to improve the quality of healthcare. The technology is also expected to provide global health communities with benefits, from improved health outcomes, reduced medical errors, and a reduction in healthcare expenditure. These benefits will not be realised unless the key stakeholders and consumers of the technology are willing to accept, adopt, and use the EHR. The purpose of this study is to identify crucial factors influencing clinicians’ adoption of the EHR in South Africa’s healthcare system by expanding the Unified Theory of Acceptance and Use of Technology (UTAUT) model to include the additional constructs Resistance to Change and Attitude Towards Organisational Change. A cross-sectional online questionnaire was used to gather data from 168 clinicians employed at various private and public healthcare facilities across South Africa. Performance expectancy and facilitating conditions were found to have a statistically significant positive impact on clinicians’ behavioural intention, whereas effort expectancy and social influence had no similar result. Resistance to change had a statistically significant negative influence on behavioural intention, and a negative attitude towards organisational change positively influenced resistance to change. The findings of this study can be used by government bodies, the private sector and technology vendors to better understand clinicians’ perceptions of the EHR in order to guide policy and effect implementation strategies accordingly.
Mini Dissertation (MBA)--University of Pretoria, 2020.
Gordon Institute of Business Science (GIBS)
MBA
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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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Boiani, Filippo. "Blockchain Based Electronic Health Record Management For Mass Crisis Scenarios : A Feasibility Study." Thesis, KTH, Skolan för elektroteknik och datavetenskap (EECS), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-254875.

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Electronic Health Records (EHRs) are both crucial and sensitive as they contain essential information and are frequently shared among different parties including hospitals, pharmacies or private clinics. This information must remain correct, up to date, private, and accessible only to the authorized people. Moreover, the access must also be assured under special conditions mass crises like hurricanes or earthquakes where disruption, decentralized responses, and chaos could potentially lead to wrong procedures or even malicious behaviors. The introduction of blockchain a distributed ledger where the records are stored in a linked sequence of blocks and are theoretically difficult to delete or tamper with made possible to design and implement new solutions for more failure-resistant EHRs applications adopting a distributed and decentralized philosophy, in contrast with the central ones based on cloud infrastructures or even local solutions. In this context, this work provides a systematic study to understand whether permissioned blockchain implementations could be of any benefit to managing health records in emergency situations caused by natural disasters. After the design and implementation of a basic prototype for an EHRs management system in Hyperledger Fabric and the execution of a set of test cases based on the simulation of the Haiti earthquake of 2010, it was possible to discuss the benefits and tradeoffs that the system entails. The discussion focused on the performance parameters like throughput, latency, memory and CPU usage. The system allowed the patients and practitioners to share and access EHRs and be able to detect and react to the crisis situations. Moreover, it behaved correctly in the presence of malicious nodes assuring throughputs and latencies still lower, compared to current centralized systems like credit card payments, but already up to two orders of magnitude higher than permissionless blockchain implementations. Even though there is still a lot of work to do, the system represented by the prototype could be an interesting alternative for networks of healthcare companies to help ensuring the continuity of treatment while preserving privacy and confidentiality in extreme situations.
Electronic Health Records (EHRs) är både viktiga och känsliga då de innehåller viktig information som ofta delas mellan flera parter, såsom sjukhus, apotek, och privata kliniker. Den här informationen måste hållas korrekt, uppdaterad, privat, och tillgänglig endast till auktoriserad personer. Vidare, tillgången till information måste vara försäkrad under extraordinära händelser, masskriser såsom orkaner och jordbävningar då distribution, decentraliserade åtgärder, och kaos potentiellt kan leda till fel åtgärder, till och med skadligt beteende. Introduceringen av blockchain en distruberad ledger"vars recordslagras i en länkad sekvens av block som är teoretiskt svåra att förstöra eller manipulera har möjligjort designen och implementationen av ny lösningar för mer krashresistanta EHR applikationer som antar en distribuerad och decentraliserad filosofi, i motsats till de centrala som bygger på molninfrastrukturer eller till och med lokala lösningar. I det här sammanhanget ger detta arbete en systematisk studie för att förstå huruvida permission-baserade blockchain-implementationer kan vara till nytta för att hantera hälso information (records) i nödsituationer orsakade av naturkatastrofer. Efter utformningen och genomförandet av en grundläggande prototyp för ett system för hantering av EHR i Hyperledger Fabric och genomförandet av en uppsättning testfall baserade på simuleringen av jordbävningen i Haiti 2010 kunde vi diskutera de fördelar och avvägningar som systemet medför. Diskussionen fokuserade på prestanda parametrar som throughput, latens, minne och CPU-användning. Systemet gjorde det möjligt för patienterna och utövarna att dela och komma åt EHR och kunna upptäcka och reagera på krissituationerna. Dessutom uppträdde det korrekt i närvaro av skadliga noder och säkerställde throughput och latens, vilket var lägre jämfört med nuvarande centraliserade system som kreditkortsbetalningar, men upp till två storleksordningar högre än permission-lösa blockchain-implementeringar. Trots att det fortfarande finns mycket arbete att göra skulle det system som representeras av prototypen kunna vara ett intressant alternativ för nätverk av sjukvårdsföretag, för att hjälpa till i extrema situationer och garantera kontinuiteten i behandlingen, samtidigt som sekretess och konfidentialitet bevaras.

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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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Carneiro, Carla Margarida da Silva. "Voluntary electronic patient record state of the art." Master's thesis, Universidade da Beira Interior, 2012. http://hdl.handle.net/10400.6/1191.

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Introduction: With an ongoing economic crisis, Portugal and many other countries are looking into ways to increase efficiencies in all sectors. With almost 10% of the Gross Domestic Product (GDP) spent in Healthcare, there is a need to improve the use of resources. A Voluntary Electronic Patient Record (VEPR) is an online record of health and healthcare related data provided by the patient himself, available to him, and his authorized health care providers and relatives, in a ubiquitous way anywhere/everywhere. According to some authors through VEPRs, every health institution could have an easier access to a summary of the patient’s most important health data if needed and authorized. Just like Portugal, Australia, for example, is currently preparing a health care reform and the implementation of a Personally Controlled Electronic Health Record (PCEHR) system is also being studied. Surveys to general practitioners and consumers of eHealth are being conducted in order to evaluate the quality and sustainability of Australia’s health care and to develop change and adoption strategies for the PCEHR system. VEPRs can be provided by private companies, hospitals and health organizations or health departments of governments themselves. In Portugal there is at least one VEPR free of charge provided by a private company. This has raised issues of security of data and risks, and has not been approved by the data protection agency, possibly due to considerations on its massive use as well as the ethical issues of linking it to national health data from the NHS. In addition to this private VEPR, Portugal also provides some health online services: eAgenda and eRNU (“Registo Nacional de Utentes”) since 2009. Currently, eAgenda allows patients to schedule for doctor´s appointments and to ask for prescriptions renewal. The online health service, eRNU, allows users to check their general practitioner, the health institution in which they are registered, the health services it provides and its opening schedule. VEPR can be efficient, allowing better sharing of information between health care providers through the online availability of health information. It can be convenient; provide easy access to timely and accurate information no matter where the patient is or when he needs it. It is empowering as it enables the patient to be more active and involved with his own health care. To ensure the privacy of the patient’s health information, a security program is required to allow only the appropriately authorized individuals to access the VEPR and to save the record’s data in case of a technical breakdown occurs. On the other hand, although everyone can have a VEPR, this is normally restricted to younger, more info-included citizens as access to the internet is not universal and there is a natural difficulty in older generations to use IT and Internet. This, however, can be mitigated and will only have a tendency to dissipate in future. Aims: 1. To assess the state of the art about VEPR; 2. To assess the state of the art about VEPR in Portugal; 3. To assess users expectancies towards VEPR in Portugal; 4. To help developing and set in motion a VEPR adjusted to Portuguese population’s health challenges. Methodology: This is a transversal study with a qualitative and quantitative approach. To elaborate this paper, a literature review was made in order to identify sources of information about VEPR and current state of the art on this field. It was established a cooperation with the Portuguese Ministry of Health as it was the only way to indirect and directly collect data about the portuguese VEPR, eAgenda and eRNU. A questionnaire composed of 14 questions, made anonymous, was created using Lime SurveyTM, named “Inquérito para utilizadores dos serviços eAgenda e eRNU”, permission obtained and it was then sent to eAgenda and eRNU users through their e-mail addresses. Data was processed using Microsoft Office Excel 97-2003 and statistically analyzed resorting to Epi Info 7. Because the last question was an open question, the related data was processed manually. Results: Currently, eAgenda and eRNU serve about 4% of the portuguese population. The typical user is female, married, completed high school, has children and age median 38, 5 years old. Own and household appointments scheduling were the more frequently selected as the most useful functionalities as well as those that most contributed to improvement on health care delivery. Waiting time reduction was the most frequent selected advantage of eAgenda and eRNU. Conclusions: It is to be concluded that eAgenda and eRNU are well suited for the portuguese population as only 3,28% of the inquired users pointed eAgenda and eRNU services has not having any advantage. More studies are still required to understand the patterns of use and to promote the online services so that more people, not only 4% of the overall portuguese population, may take advantage of their benefits.

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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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Dissertations / Theses on the topic 'Electronic health record'

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