Dissertations / Theses on the topic 'Electronic Records Management'

Objectives: First, to identify the core Electronic Health Records (EHR) functionalities available to physicians who work in private and public health care facilities in Trinidad and Tobago and the extent to which physicians are using each function. Second, to understand the rate of adoption of Electronic Health Records in private and public hospitals/clinics, and finally, to identify the barriers to adoption of Electronic Health Records in private and public hospitals/clinics in Trinidad and Tobago. Background: The two largest public hospitals in Trinidad and Tobago, Port of Spain General Hospital and San Fernando General Hospital, utilized paper medical records. In Trinidad and Tobago, there is little known about the EHR functions available and being used, adoption rates, and barriers to adoption of EHR in the private and public sectors. Method: Electronic Health Records (n = 130) questionnaires were sent to number of health care practices in the private and public facilities in the five regions of Trinidad and Tobago, in order to understand availability and use of EHR, adoption rates, and barriers to the use of EHR. Results: The most commonly available function for the private and public physicians was Health Information and Data with respective scores of 58% and 29%. Sixty-three percent of the private physicians who adopted EHR reported using the Result Management and Order Management functions. The public physicians who had adopted EHR reported they were not utilizing the Decision Support, Result Management, and Order Management functions. There was no statistical difference between private and public physicians for the available and used functions. A total of 53 private and 19 public physicians responded to the survey (55% response rate). Thirteen (25%) private physicians reported adopting EHR and 2(11%) public physician reported adoption of EHR. Private and public physicians cited start-up cost and technical limitations of systems as the barriers to their practices' adoption of EHR. Conclusion: Findings showed the same availability and use of core functionalities, as well as adoption rate among the private and public facilities, and slightly fewer barriers in the private practices. A larger sample is merited to understand if there is any statistically significant difference between the two groups.

This master's thesis will present a literature review and analysis ofthe implementation and use of Electronic Medical Records (EMR). The literature review will discuss reasons that support implementation of EMRs, factors that are necessary for successful implementation and barriers that impede implementation. Also, real-world examples of implementation for medical billing in healthcare organizations will be discussed, as well as the disparity in implementation rates between larger and smaller healthcare organizations.

The analysis portion of this thesis will include data from the 2009 National Ambulatory Medical Survey (NAMCS) EMR Supplement and, through the application of the Chi-Square statistical test using SPSS, will assess whether size of the medical practice in terms of number of physicians is significantly associated with EMR implementation and functionality, the latter of which includes clinical reminders and prescription ordering. It will be shown that physician size is indeed significantly associated with implementation and functionality.

ABSTRACT Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals? perceptions of the use of EMRs at a hospital division of a major medical center. The study findings highlighted the challenges in transitioning from paper records to EMR despite the many benefits and potential improvement in health care. A description of the 16 health care professionals? perceptions of EMR use emerged by adopting the unified theory of acceptance and use of technology (UTAUT) model and NVivo 10 computer software to aid with the analysis of semi-structured, recorded, and transcribed interviews. Themes emerging from the analysis were in five categories: (a) Experience of health care professionals with a subtheme of workflow, (b) Challenges in transition from paper to EMR, (c) Barriers to EMR acceptance, with a subtheme of privacy, confidentiality, and security, (d) Leadership support, and (d) Success of EMR. The findings of the case study may inform health care industry decision makers of additional social and behavioral factors needed for successful EMR strategic planning, implementation, and maintenance.

Background: Obesity has recently been classified by the American Medical Association (AMA) as a disease which, if unrecognized and unaddressed in childhood, causes multiple medical and psychological complications that can impact both personal and population health. Unprecedented funding is being invested in electronic health records to improve quality, safety, and delivery of healthcare and reduce healthcare costs. Scant literature has evaluated the use of aids in the electronic health record (EHR) to identify obesity.

Objectives: The purpose of this study was to determine to what extent the tools available in an EHR for automatic Body Mass Index (BMI) calculation based on height and weight documentation are used by pediatricians to correctly identify obesity in children. Secondary objectives were to evaluate quality of data input (discrete vs. free text) and see if there is any variation in rates of identification among patients of different socio-demographic characteristics and trainees of different levels.

Methods: We conducted a retrospective chart review for patients aged 2–18 years seen for a well-child visit at New York Presbyterian Hospital between January 2011 and January 2014, where it is standard practice at these visits to take height and weight measurements. The EHR automatically populates these values onto growth curves, converting them into BMI with percentiles. Standardized definitions from the Centers for Disease Control and Prevention (CDC) 2010 were used to qualify overweight and obese based on BMI. We determined the percentage of patients who were overweight or obese (based on CDC percentiles) that had the diagnosis identified by the pediatrician, and then assessed the quality of data input. We assessed laboratory follow up and referrals for all patients, and assessed for demographic differences among patients properly and not properly documented by providers as obese or overweight.

Results: We reviewed 700 charts in total. Inclusion criteria were all of the patients who had a BMI between 85–95% (these were grouped as overweight) and a BMI over 95% (obese). 209 patients were overweight or obese and therefore eligible for inclusion. Of the 209 clinically overweight/obese children, 72.2% had some form of documentation of this diagnosis, although the diagnosis was documented more often in the obese vs. overweight child. The diagnosis was most often captured electronically in the free text progress note. Over half of clinically overweight/obese children aged ≥8 years did not receive follow-up standard laboratory testing, and only about one-quarter of clinically overweight/obese children had documented in-office nutrition guidance. Diagnosis of overweight was higher in females, but it was almost twice as likely that an obese male would be documented as such. Results showed no identification variation based on age or race/ethnicity. There was no difference in recognition of obesity/overweight based on postgraduate year (PGY) or nurse practitioner (NP) status.

Conclusion: Despite its importance as a public health priority for children, automatic calculation of BMI by use of an EHR led to documentation by a provider as a child being overweight/obese only three quarters of the time. This study suggests that despite increasing focus on using EHRs to improve individual and population health, including for obesity, clinical decision support remains underutilized.

A major initiative in the U.S. healthcare care industry is to establish a nationwide health information network securing the sharing of information between all involved U.S. healthcare stakeholders. However, implementing an interoperability solution is a massive, complex, and enduring effort with significant challenges such as inconsistent technology and data standards, as well as complex privacy and security issues. The purpose of this qualitative, case study is to examine the impacts of interoperability initiatives involving the U.S. government and to provide an understanding of the information governance and security risk as standards that are vendor-neutral and trustworthy. This qualitative case study was conducted using federal participants who are health information management (HIM) and health information technology (HIT) professionals working in the Washington DC metropolitan area. The participants' interview data revealed nine major themes; patient identification matching, payment claims and auditing, information sharing, data stewardship, regulatory compliance, technology enhancements, training and certification, standards optimization, and value-based care. The implication of the study's themes showed interoperability is beneficial to the healthcare industry, but there is a greater need for technology and data standardization, information governance, data stewardship, and a greater understanding of federal and state data privacy and security laws. Future recommendation for practices discussed; policy and regulatory adjustments to enhance auditing and compliance, establish a healthcare data ecosystem to improve data and information governance, and technology alternatives such as master data management and white space data. Recommendation for further research included expanding the sample population to compare other federal organizations or the United Kingdom's HIT interoperability project initiative.

The general problem is Native American tribes have high prevalence rates of diabetes. The specific problem is the failure of IHS sites to adopt EHR may cause health care providers to miss critical opportunities to improve screening and triage processes that result in quality improvement. The purpose of the quantitative correlational study was to explore a possible correlation between electronic health record use and reductions in diabetes co-morbidities. The study involved examining over 10 years of ex post facto data, with over one million patient encounters, from the Resource and Patient Management System database. Electronic health records containing key components such as clinical decision support with clinical reminders, evidence-based guidelines, template-driven protocols, and algorithmic modeling changes clinical provider behavior resulting in quality improvement. The study identifies the theoretical constructs from over 50 years of literature that converge to support quality improvement using electronic health records. Quality improvement theory and the unified theory of acceptance and use of technology were examined to explore relationships between process changes and behavioral modification. Results revealed a significant positive correlation between total blood pressure control screenings and the diagnosis of hypertension for fiscal years 2005 – 2009 r(4) = .947, p = .007. A significant positive correlation also existed between blood pressure control screenings with values >130/80 and diagnosis of hypertension for fiscal years 2005 – 2009 r(4) = .909, p = .016. The study concludes with a rejection of the posited null hypotheses, revealing a statistically significant correlation between use of a comprehensive electronic health record and health care quality improvement.

The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have been completed that pertain specifically to behavioral health-care clinicians. The study purpose was to examine the relationships that may exist between behavioral health-care clinician perceptions of usefulness and ease of use and demographic variables on adoption of the EHR. Regression analyses were performed to test the relationship between behavioral health-care clinician personal characteristics, their perceived ease of use and usefulness of EHR, and their attitudes toward adoption of the EHR. The study utilized licensed marriage and family therapists as participants. The Physician’s Survey Questionnaire Form was adapted to the needs of this study and utilized as the survey instrument. The study was embedded within the frame of Roger’s diffusion of innovations theory and the technology acceptance model. The findings of the study suggest that older clinicians are less likely to perceive the EHR as useful in their professional practice. The results also demonstrate that behavioral health clinician perceived ease of use and usefulness of EHR is positively associated with attitude toward adoption of the EHR. The findings indicate that to improve the adoption of the EHR for behavioral health clinicians, the EHR needs to be viewed as useful. Interpretation of the results and suggestions for future research are offered.

Electronic Medical Records (EMRs) are increasingly being used in healthcare organizations. However, there are few factors influencing the physician adoption rate of EMRs. The purpose of this paper is to investigate the meaningful use incentives, and the type of specialty practices in relationship to the physician use of EMRs. Data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed to how meaningful use incentives and the type of physician practices affect the physician use of EMRs. The Chi-Square test and ANOVA test have been use to examine the hypothesis, and the association was found to be statistically significant.

This study analyzes the effect of payor mix in the adoption of Electronic Health Records (EHR) among physicians in the United States and whether or not this adoption has been incentivized by the Medicare and Medicaid incentive programs. The study predicted that payor mix influenced adoption and that practices with higher percentage of patient care revenue coming from Medicare and Medicaid would present higher levels of adoption. It also predicted that physicians planning to apply for Medicare and Medicaid incentive programs are more likely to adopt this technology. The Statistical Package for Social Services was utilized to analyze the 2010 National Ambulatory Medical Care Survey data using Chi Square statistics. The results of this study showed a significant relationship between payor mix and EHR adoption and incentive payments and EHR adoption. The findings of this study are valuable for medical practices, EHR vendors, hospitals and government entities to strategize on additional incentives and financial assistance programs that foster meaningful adoption and improve healthcare outcomes.